I beg to move,
That this House
notes that almost ten years of Government cuts to council budgets have resulted in a social care funding crisis which means 1.5 million older people have unmet social care needs;
further notes the increasing funding gap for adult social care;
believes proposals from the Government for access to additional funding for both adult and children’s social care will do nothing to ease the crisis or address the funding gap;
and calls on the Government to bring forward as a matter of urgency plans to reform social care including plans for free personal care.
It is right that we have a chance to debate social care today: it is two weeks ahead of the Budget and there is the ever present hope that the Government will announce much-needed social care reform. This reform is long overdue. After nearly a decade of cuts, our social care system is on its knees. For the people who rely on social care and for their families, the reality is that things have got much worse under successive Conservative Governments. Every day last year, 2,000 older people who had approached their local authority for help with social care were turned down. The result is that there are currently 1.5 million older people who are not getting the support they need—each one struggling to cope with basic everyday tasks. This can mean people left trapped in bed all day or going unwashed all week, because family carers can visit them only on the weekends, and those are the people who are fortunate enough to have help from unpaid carers. Around half the 1.5 million get no help at all—not even from family and friends. They cope as best they can until they end up in hospital, and then they cannot get out of hospital because they can only be discharged safely once a social care package is set up, with the local authorities struggling to find the funding for it.
Another failure in our social care system is where people are held in entirely inappropriate institutions because the local authority cannot fund the care they need to keep them safe in the community. There are 2,200 autistic people and people with learning disabilities who continue to be detained on in-patient wards. This is one of the most egregious failures of our social care system. They should be able to live in their own homes with a support package, but the funding is not there. For eight years the Government have been promising to end this scandal, but they have failed to do so.
My hon. Friend is making a great start to a very important speech. Does she agree that it is quite astonishing that the Equality and Human Rights Commission has been forced into a position where it is having to threaten to take action over the Government because of their failure to accommodate people with autism and learning disabilities, and it is people who are suffering as a result?
I absolutely agree with my hon. Friend. The only way that we will see real change is if the Government put in funding to provide the housing and support needed for those people currently trapped in inappropriate institutions. I first raised this issue with the Secretary of State in October 2018, citing the case of a young autistic woman called Bethany. It took 14 months before Bethany was moved out of a seclusion cell and into a more supported environment. Now we have, as my hon. Friend has said, the Equalities and Human Rights Commission launching a legal challenge against the Department for its failure to move those 2,200 autistic people and people with learning disabilities out of those inappropriate units.
We must see action on this issue, because it is a national scandal. We need to see reform so that more people can get the care they need, rather than being left to struggle on alone. Even when people are able to access publicly funded care, there is no guarantee that it will be of acceptable quality. Last year, one in six social care services was rated by the Care Quality Commission as “inadequate” or “requires improvement”. That can mean care homes that are so unclean that residents are at risk of picking up infections. It can mean home care agencies that have not even carried out basic checks on their staff, or home care staff being so rushed that they do not have the time to take off their coats during a visit.
Twenty per cent of councils in England and Wales still commission 15-minute care visits. That is clearly not long enough to provide care. It is not long enough to get to know someone and support them to do the things that they want to do.
A German style system of social insurance would allow somebody who is defined as needing social care to draw down a certain amount of money which they could then use to pay to a relative, a loved one, or a neighbour who understands that person best and who can care for them best. Is that not a sensible basis for a cross-party discussion, between the Opposition and the Government, about whether a German style social insurance system could solve this problem?
I thank the hon. Gentleman for making that point; he does make it on every occasion that we debate this subject, so I congratulate him on doing so again. However, the person he needs to be directing his comments about cross-party talks to is sitting on the Government Front Bench. I am hopeful that the Secretary of State is going to tell us what he is going to do about cross-party talks, because those 15-minute visits are really not good enough.
I agree entirely about the need for cross-party consensus on this issue, but there can be no consensus until there is an acknowledgement of what has caused the care crisis—the underfunding of the health service and cuts to local government budgets, which have had an impact on A&Es, GPs and other services. Until there is an acknowledgement of what caused the situation, there can be no consensus towards a solution.
My hon. Friend is right. I will come to the causes, because it is important to mention them.
The 15-minute care visit reduces the giving of care by care staff to a series of physical tasks, rather than the staff being able to see a person with their own interests, desires and opinions. It really strips them of the time to do the job they want to do. I pay tribute to all care staff, who go above and beyond in their jobs to improve the lives of the people they support. Without them, our social care system would not work, but they do not get the pay and recognition that they deserve.
Care staff, who provide essential practical and emotional support to some of the most vulnerable people in society, are among the most poorly paid workers. The average hourly pay for care staff is below the rate paid in most UK supermarkets. On average, care staff are paid less than cleaners and healthcare assistants in the NHS, and this has led to a vacancy rate of 122,000 care jobs and a turnover rate of 33%. Now the Government are planning to make the situation worse by turning away people who want to come to this country to work in social care. One in seven care workers is from outside the UK, but the average care worker earns £10,000 a year less than the Government’s immigration salary threshold, so will the Secretary of State tell us just how he thinks he is going to be able to fill the large number of vacancies in the social care workforce?
My hon. Friend is making a powerful speech. Does she share my concern that poor pay and conditions mean not only that these workers are exploited, but that there is a high degree of turnover and a lack of investment in training and development, which in themselves have a significant impact on the quality of care that is delivered to some of our most vulnerable residents?
Once again, I absolutely agree. My hon. Friend is right to emphasise that point.
Last week I met home care support workers in my constituency who are campaigning to be paid a real living wage, and they told me about their struggles to manage financially. One staff member talked of working 90 hours for four consecutive weeks at an effective rate of £6.10 an hour. Others talked about being bitten or punched, yet still they continue to do the support job that they love. I pay tribute to their commitment; in the case of social care, doing a rewarding job does not pay the bills.
Does my hon. Friend agree that far too many essential careworkers are employed on zero-hours contracts, which we really need to see kicked into history?
I very much agree. We need to pay care staff the real living wage, provide them with training and end the use of zero-hours contracts.
I think it is clear enough that the Labour party believes that the current system is not working, and I am sure that the Secretary of State knows it too. Councils just do not have the funding required to deliver the care that people need, and they are faced with a stark choice—either they cut back on the quality of care, or even fewer people receive any help at all. Only a third of directors of adult social services think that their budget will be enough to meet their statutory duties this year, which means that thousands of people who approach their local authority for help with their care are turned down for support. Without investment and a plan, social care services will be pushed deeper and deeper into crisis. Expert report after expert report has pointed to social care being on the verge of collapse, and those reports make it clear that councils cannot deliver adequate adult social care provision without a sustainable, long-term funding strategy. Yet what we have seen from the Government, year after year, is short-term and piecemeal funding.
The Secretary of State may repeat, as his colleagues did yesterday, that the Government are allowing councils to raise council tax this year to fund social care services, but the Opposition know that council tax is a deeply unfair way to fund this vital public service. A 2% rise in council tax rates in Wokingham will raise twice as much money as it would in Knowsley. Even if we raised council tax by 2% every year, the Institute for Fiscal Studies says that by the end of the decade social care will make up over half of all local government spending. This means that other vital services will continue to be cut back. That is certainly the situation I see in my own local authority area.
The shortage of resource and people in the system means that more responsibility falls on families. I know that my hon. Friend recognises the unsung heroes who are young carers—children who miss out on education, a social life and so much more to care for a parent or sibling. Does she agree that the Government need to do more to help to support organisations like the Eastern Ravens Trust in Stockton, which does so much to help these young carers to have a life of their own?
Indeed I do. I am looking forward to the establishment of the new all-party group on young carers, but it is tragic, in a way, that we have to meet in new all-party groups to try to find some way of taking the burden from those young carers.
As local authorities struggle to fund social care, an increasing number of people are forced to take on the financial burden themselves. Some 143,000 people are currently faced with catastrophic costs of over £100,000 for their own care. Over the past three years, 9,000 people have asked their local authority for help after completely depleting their own savings to pay for their care. This means that people are having to sell their homes that they may have lived in for their entire lives to fund the care that they need. The Prime Minister has promised to stop this situation, but with no plan and no proposals for how he achieves that, it is likely that many more people will be put in this position going forward. The Government could drastically reduce the number of people faced with catastrophic costs for their care if they set a lifetime cap on care costs. The Government proposed a cap in 2013. They legislated for it, but dropped it in 2016. That cap would have gone some way towards reducing the number of people now faced with catastrophic social care costs. The Government’s own impact assessment showed that by this year 37,000 people would have benefited from the cap if it had been introduced in 2016.
But reform is not just about protecting housing wealth. It is important to do that, but reform also has to offer a solution to the people who are currently stuck in bed all day unable to get themselves dressed, or needlessly stuck in hospital. The solution that Labour favours is to offer free personal care to ensure that everyone is supported with the basic tasks regardless of their ability to pay. Free personal care was introduced by a Labour-led Government in Scotland in 2002, and it is ensuring that more people there receive publicly funded social care. Free personal care has been backed by the House of Lords Economic Affairs Committee and by charities and think-tanks.
We believe that it is vital that we push forward with this reform because progress to date has been far too slow. In October 2018, the Secretary of State talked about:
“The adult social care Green Paper, which will be published later this year”.—[Official Report,
In 2019, we were told that there would be a Green Paper “that summer” that would set out the future of social care, but it never arrived. It was delayed twice before being dropped completely. Seven months ago, the Prime Minister stood on the steps of Downing Street and said that he had a plan to fix the social care crisis. There is still no sign of it. Perhaps this plan is in the same state as the promised Green Paper. The Government said that they would instigate cross-party talks on social care within the first 100 days of the election. We are now 75 days on and we have yet to hear from the Government on their proposals.
Labour is the only party, as it stands today, with clear plans for the future of social care. Labour’s plan for social care would close the funding gap, cap care costs, and introduce free personal care and improved pay and working conditions for care staff. In contrast, we have no action from the Government on social care. Councils are reliant on piecemeal funding announcements and raising ever higher levels of council tax, yet these measures leave them struggling to meet demand. So Labour’s message to the Prime Minister and the Secretary of State is clear: they need to put in the extra investment needed to stabilise the care system, introduce free personal care, bring back a cap on care costs, and develop a plan to improve the pay and working conditions of the care workforce. I want to make it clear that Labour will be happy to sit down with Ministers and talk them through our proposals, as the Prime Minister does not appear—at this point in time, at least—to have any plans of his own. I urge hon. Members to vote for our motion tonight to ensure that the Government have to finally meet their pledge to fix social care.
I beg to move an amendment, to leave out from “House” to the end of the Question and add:
“notes that the Government is committed to fixing the crisis in social care;
and supports the Government’s commitment to find a long term solution for the growing need for care and commitment to an ambitious three point plan, including extra funding every year, seeking a cross party consensus and ensuring the prerequisite of any solution is a guarantee that no one needing care has to sell their home to pay for it.”
This is a welcome opportunity to debate social care—a subject of vital importance—and I want to set out how we must rise to the challenges and celebrate all that is good. We must recognise at the start of the debate that there is much to celebrate, including the millions of people who work in social care, to whom we pay tribute. I want to welcome someone who is new to working in social care: my hon. Friend Helen Whately, who has joined the team as Minister for Care. I pay tribute to her predecessor, my hon. Friend Caroline Dinenage, who led the care system so effectively and delivered a legacy of better training, better recruitment and a real focus on carers; that is a legacy to be proud of.
Let me start with the context for this debate. It is rightly about both adults of working age and older adults. The people of this country are living longer. Over the next decade, the population aged 75 and over is set to increase by 1.5 million, and over the next 20 years, the number of people aged 65 and over is set to increase by almost half. That is emphatically a good thing. More people living for longer is not some problem to be managed; it is an opportunity to be welcomed, and welcome it we do.
My right hon. Friend is right to highlight the significant challenge that an ageing population with multiple medical co-morbidities presents to the health and care system. In that context, it is not just about extra funding, which is obviously welcome to the care system; it is also about transforming the way we deliver care. Is it not time to consider a single point of commissioning for health and social care? If we were designing the system today, given the demographic challenges he has outlined, it would look very different from the system we have.
My hon. Friend is right that it is about more than just money. The money is, of course, important, but it is also about how the system is structured. There are parts of the country where the co-commissioning he calls for already exists, and we can see the improvement in efficiency that we get out of that. Barbara Keeley rightly mentioned those with learning disabilities and autism, of whom there are more than 2,000 in in-patient settings. We are reducing that number and supporting more people to move into the community, including in the example that she mentioned. She talked about the challenge of that requiring more money. Actually, community settings are often better for the patient and cost the taxpayer less. As my hon. Friend says, improving the commissioning and the system is a critical part of the solution, so that yet more people can be moved out of in-patient settings.
The Secretary of State talks about transforming care and services so that we focus more on prevention, early intervention and help in the community and at home. That is what we should be doing, so why, as the National Audit Office has just reported, have we seen less money spent on public health, primary care and community care under this Government in the last five years? This Government are obsessed with hospitals, which is not the way that we want to go—it is about care in the community and at home.
The hon. Lady is dead right, and I have changed that direction of travel. This year is the first year for a generation when there has been an increase in the proportion of the NHS budget going to primary and community care. That change was at the core of the long-term plan. I insisted on that because I entirely agree with her analysis that getting more support out into the community is critical. This has been going in the wrong direction for a generation, and we are just starting to fix it.
I want to pick the Secretary of State up on the point that he made a few moments ago. We had an exchange at the end of January about life expectancy. He says that life expectancy is increasing. It is absolutely clear from Professor Sir Michael Marmot’s report, and it has been clear since 2017, that life expectancy is stalling. Sir Michael said that
“life expectancy actually fell in the most deprived communities outside London for women and in some regions for men.”
I have written to the Secretary of State and I have not yet had a response, but he has an opportunity to correct the record now.
I saw the letter and I absolutely will reply to the hon. Lady. What I have said before, and I repeat now, is that life expectancy in this country is rising. There are parts of the country where that is not true.
It is not flat, it is rising, and it is really important that this debate, which is so critical, is based on the facts. The increase in life expectancy should be shared right across the country, and it is not, and we are determined to fix that. We are determined to ensure that life expectancy in this country rises everywhere. That is not the case and it needs to be the case, but life expectancy overall is going up. That is the fact.
The report says that it has almost ground to a halt since 2011. These are the facts, and there is an onus on the Minister to be absolutely clear about this. We cannot fudge this issue.
The Secretary of State will have seen Sir Michael Marmot’s report, launched today. Indeed, one of his own departmental officials spoke at the launch, because he could not make it, and said that no one could disagree with the analysis. Sir Michael Marmot says that life expectancy advances are flattening and even going backwards—they are decreasing—for the poorest 10% of women. Is Sir Michael Marmot wrong? Is that what the Secretary of State is saying?
No. What I am saying is that life expectancy, as I have repeated, is going up, but there are areas where it is not, and we will and we must tackle that. The challenge for us as a country is not to try to pretend that things are different to the facts. The challenge here, which Opposition Members will not accept, is that there are parts of the country where life expectancy is advancing rapidly and there are parts where it is not, and we must tackle that. We cannot have a decent policy conversation if half of the debate will not accept the facts on the ground.
The Marmot report was published this morning. It is absolutely critical that we level up life expectancy. The fact that in Blackpool a healthy life expectancy for men is 53 years yet in Buckingham it is 68 years is a disgrace, and we will put that right, but you cannot put things right if you ignore the facts when you are starting.
I just want to round this point off. What does the right hon. Gentleman think happens with life expectancy when 1.5 million older people are going without care? Does he not think that the impact of the lack of social care, especially on women in deprived areas, is a key factor?
No, I do not recognise those figures because they are not the accurate representation of what is actually happening. There are many within that figure who are judged under legislation to need to pay for their own care, and they do. We have to start from a basis of fact and, frankly, until Labour Members start working on this from a basis of fact, it is very difficult to take their contributions seriously.
The critical thing is that, as life expectancy is increasing, more people are looking forward to ageing in comfort and dignity, and that is good news. Opposition Members may not like it. It is odd; they do not seem to want to think that life expectancy is going up. We have a duty to ensure that our social care system is equal to the task. There are many things we should be proud of in our social care system, although we would not have gathered that from the speech by the hon. Member for Worsley and Eccles South. Some 84% of providers of social care are rated as good or outstanding, and 90% of people who receive care are satisfied with its standard. The proportion of adults with learning disabilities living in their own home or with their family has increased every year since 2014-15. That is good news, which we should welcome.
Is my right hon. Friend not right to say that life expectancy is continuing to go up? We would expect it to slow down, because we are not all going to live forever. The key thing is not just how long we live for; it is how long we live a high-quality, healthy life for.
My hon. Friend is absolutely right, and that is the sort of analysis on which we can make decent policy progress, because it based on the facts, rather than on making things up.
I will write to the hon. Lady to give her the facts. Do Members know what the facts will say? The facts show that life expectancy is going up—I think I have made that point. Opposition Members may not like the fact that things are getting better in this country, but we will make sure that we level up, so that things get better in all parts of this country. We welcome progress, but we demand more.
I am going to make some progress and talk about the long-term solutions we are seeking on social care. For all its many strengths, it is clear that the system cannot remain as it is. Three out of four over-65s will face some care costs in their lifetime, and approximately one in 10 will face lifetime costs of more than £100,000. We need a long-term funding solution, so that the system can continue to do all that we ask of it long into the future. Crucially, we need a solution that solves the problem, commands the widest possible support and stands the test of time. We know in this House that that challenge has been ducked for many years; we have had more than a dozen commissions, reviews and reports, and more than two decades of inaction, from Governments of all political stripes. We do not need another commission —we need a plan. So in our manifesto we set out our three-point plan to solve the crisis, as referred to in our amendment tonight, which I hope the whole House will support.
The first point is to deliver the funding that is needed now to stabilise the system. The funding will provide certainty for local authorities and providers while we put in place the long-term solution. At the last spending round, we said that would make an extra £1.5 billion available in 2020-21. That includes £1 billion of additional grant funding and the 2% adult social care precept, allowing councils access to a further half a billion pounds. Overall, that is part of a 4.4% real-terms increase in local authority core spending in 2021, and that spending comes on top of £2.5 billion in existing social care grants that will be maintained. All in all, our investment since 2015 has allowed an 11% cash-terms rise in social care spending by councils. So the amount of money going into the system is going up, and I am very glad about that, but clearly further progress needs to be made.
The £1 billion comes from general taxation and the half a billion comes from the social care precept, and we have been absolutely clear about that.
The second part of the plan is to recommit to seeking a cross-party solution. In my view, past attempts at reform have not failed for lack of ideas or good will on the part of many people and many policy makers; they have failed because solving this problem is not just a task of policy making, but an act of political economy. The consequences of the decisions on the reform of social care will play out over decades and, as with past reforms—for instance, pension auto-enrolment—this is best done with cross-party support.
Last year, Gillian Keegan, Damian Green and I set up the all-party group on social care. We produced a report on the professionalisation of the workforce, which looked, in particular, at the undervaluing of the wider workforce in pay, training and qualifications. Will the Secretary of State commit to looking at that report, as the basis of his cross-party consensus?
Yes, I have. As the hon. Member knows, my hon. Friend Gillian Keegan was my Parliamentary Private Secretary, and we talked about this a lot, so I welcome that work. Indeed, the amount of work from various Select Committees and groups in this House has been considerable, as my hon. Friend Kevin Hollinrake made clear earlier. There has been an awful lot of reports and of very good work, including the work to which the hon. Member has contributed.
The right hon. Member knows that I raised with him on the day of the first Queen’s Speech, in October last year, the need for us to set up cross-party talks. He has done nothing about that since then—nothing has happened on that. There was some vague talk about sitting down with the former Minister for Care for a cup of tea, but that is not cross-party talks. Will he say now: is he going to set up cross-party talks?
We will fulfil all the commitments in the manifesto, which, as the hon. Member set out, includes one on this subject, and that is part of our plan.
The honest truth is that that decision was made in the 2015-17 Parliament, and it was a decision the Government made at the time. I think that we need to take action to solve this problem, and that is what we are planning to do. The third part of the plan—[Interruption.] Well, I am halfway through explaining the plan.
The third part of the plan is to seek a solution that brings dignity and security to all those who need social care, with a system in which nobody needing care is forced to sell their home to pay for it. Such a solution would go against one of the most basic human impulses, which is the drive to provide for one’s family. We want to encourage people to save and we want to reward them for the fruits of their endeavours. As we said in our manifesto, we want to guarantee that
“nobody needing care should be forced to sell their home to pay for it.”
We are determined to tackle this challenge in this Parliament, and to bring forward these reforms.
Fixing the funding, as my hon. Friend Dr Poulter said, is only half of the equation, and the other half needs attention, too. We should be helping more people to live at home for longer; finding a cure for dementia, because we refuse to accept that dementia is an inevitable part of ageing; and harnessing technology to improve care. The stereotype of social care as a kind of digital backwater is increasingly out of date; there are many examples of brilliant social care organisations, public and private, using wearables and new technology to support the round-the-clock care that they give. We should also be breaking down the silos between health and social care. We will always support our carers, both paid and unpaid alike.
In the 1990s, the Germans were grappling with exactly the same problem we are grappling with now, with regional imbalances, a postcode lottery in funding and a lack of a cohesive social offer. They came up with social care insurance—there was cross-party consensus, and it is now not a political issue—and it works. Will the Secretary of State look at that model?
That is the sort of contribution I think we need in this debate. We should not be saying, “We have one answer, and we won’t engage on anything else”, but saying, “Here is an interesting answer, and let’s solve it.” We are committed to solving it in this Parliament. We will not duck the difficult decisions, we will take the action that is needed and we will secure the future of social care in this country. As we are increasingly an older society, let us also be a wiser society, and commit to fixing this problem once and for all.
It is a pleasure to take part in today’s debate on social care. As we know, social care covers all forms of personal and practical help for children, young people and adults who need extra support. It covers services such as care homes and other types of help, including supporting unpaid carers.
The Conservative manifesto contains one expensive pledge on the future financing of social care, saying that
“nobody needing care should be forced to sell their home to pay for it.”
It seems to me that the Conservatives have a large hole in their manifesto costing, which would imply additional tax increases, more borrowing or public spending cuts elsewhere. It remains to be seen what comes to pass.
Social care is a wide-ranging topic and in Scotland it is of course devolved. We are proud of what we have achieved in Scotland and what we continue to achieve using our devolved powers. All four UK national health services face many of the same challenges of increasing demand, workforce shortages and tight finances, but the NHS in England has of course faced almost a decade of unprecedented austerity. In Scotland we do some things differently from the rest of the UK. For example, the Scottish Government spend 43% more per head on social care. We are the only country in the UK with free personal care, which we recently extended to all under-65s who need it, and that now benefits nearly 80,000 people, including more than 10,000 self-funders in care homes. It gives people peace of mind and security. That is not without cost and challenges, but it helps to reduce delayed discharges and it reduces emergency admissions, and on balance it is estimated to be cost-effective. The Scottish experience would certainly support the call for the UK Government to bring forward plans for free personal care elsewhere in the UK.
Despite UK Government cuts to the Scottish budget, in Scotland we are continuing to invest in social care and integration, and the integration is one of the most significant reforms since the creation of the NHS. Of course the devolved Administrations do not operate in isolation and policy decisions from Westminster continue to have an impact on social care. Brexit, for example, is going to be potentially catastrophic for the Scottish social care sector, and while we remain within the Union it will impact upon us.
The Expert Advisory Group on Migration and Population report warns of the damage that ending free movement will inflict on social care in Scotland, saying
“the overall reduction in EU immigration would be especially challenging for those sectors most reliant on lower-paid, non UK workers, including occupations such as”— you’ve guessed it—
My hon. Friend is making an excellent speech. Does he agree that we must realise and champion the great skills that social care workers have? It is not about earnings in this case; it is about our gratitude to them for looking after some of the most vulnerable people in society, and that should be recognised by Government.
I agree wholeheartedly with my hon. Friend: we cannot put a price on the care that people get.
To return to the expert advisory group report, it said that in the social care example, reduced migration could adversely affect female family members who themselves are most likely to exit the labour market to cover gaps in care provision that would have otherwise been delivered by a migrant workforce.
In the last Parliament my hon. Friend Brendan O'Hara lobbied the UK Government to evaluate the effects of EU withdrawal on the health and social care sectors through his private Member’s Bill. No fewer than 102 third sector organisations, trade unions and charities have publicly supported the measures in the Bill, and more recently the UK Government have made it clear that they will not commit to aligning with EU standards or accept the jurisdiction of the European Court of Justice. Addressing the Scottish Parliament’s Culture, Tourism, Europe and External Affairs Committee, Cabinet Secretary for the constitution, Michael Russell, said:
“this would result in new barriers to trade and exports, a fall in national income compared to EU membership and damage to social care and the NHS.”
The SNP Scottish Government will be introducing a new continuity Bill to the Scottish Parliament soon, which would make it easier to align with future EU standards in such areas as the environment and human rights.
My hon. Friend is making an excellent point about the fact that things are different in Scotland because we have the ability to make some different decisions, and of course the Scottish Government have had a focus on preventive spending, which is largely why we are in this situation. Does my hon. Friend agree that unless the UK Government seriously acknowledge the need for regional variation in terms of immigration policy, all that work in terms of preventive spending will mean more problems for us down the line in 20 or 30 years’ time, and if the UK Government are to be so pig-headed about it they should devolve the powers to the Scottish Parliament?
I fully agree with my hon. Friend, and he has read my mind as that is exactly the point I was coming to in my speech.
The Home Office proposals for a new points-based immigration system will be hugely damaging to the social care sector in Scotland. The UK Government have reneged on their promise to deliver an immigration system that works for the whole of the UK: it does not work for it at all. Scotland needs people to contribute at all levels of the economy in vital, challenging roles in social care and elsewhere.
The Expert Advisory Group on Migration and Population reports that
“less than 10% of those in caring personal service occupations in Scotland earn above £25,000”.
The Nuffield Trust advises that
“the proposed new migration system will soon bar people from coming to the UK to work in most frontline social care jobs, even if these are defined as a shortage occupation” where the proposed lower minimum income limit of £20,480 far exceeds the average salary of a full-time private sector care worker, which in the UK is £16,200 per year. I am pleased that the Scottish average is higher than that, but it still falls far short of that income criteria.
The UK Government’s supposition that people working in social care are “low skilled” is, quite frankly, offensive. We value all those who contribute to our economy and society and they are welcome in Scotland, wherever they come from. The UK Government have ignored the evidence presented to them by the Scottish Government, businesses and industry on Scotland’s labour market needs. Donald Macaskill, chief executive of Scottish Care, told BBC Radio Scotland:
“This immigration proposal, far from enhancing the economic wellbeing of our country, will put a lot of the care sector, a lot of hospitality and other sectors in Scotland at considerable risk.”
He went on to add:
“What is low-skilled about a worker being with somebody at the end of their life, or somebody giving comfort to an individual with dementia?”
Those are sentiments I am sure we could all agree with.
I am in no doubt that social care will be damaged by the proposed immigration proposals, not least because a significant proportion of social care workers are from Europe. If we are to fix the problems of social care workforce shortages, we need an immigration system that is fit for the purpose. With existing workforce shortages added to the pressure to recruit, which is going to become harder as a result, combined with the number of Scots over 80 with social care needs set to increase by 68% by 2036, we face a very serious challenge. If the UK policy does not meet our requirements, then at the very least Holyrood must be given the powers to develop a separate Scottish visa to protect our public services and our economy. Of course, what we really need are the normal powers of independence.
Order. The debate is well subscribed. I am not imposing a time limit at this moment, but the indication is about six minutes. If everybody shows self-discipline, we hope to get everybody in.
I feel like I am in groundhog day. It is approximately two years since I responded to a very similar debate secured by Barbara Keeley. It is disappointing that we are still debating the very same issues that we were then. Of course, there has been much water under the bridge since then in our broader politics in that time, but in respect of social care, to coin a phrase, nothing has changed. The questions we need to settle are exactly the same as they were then. I say very gently that with Brexit done and with a majority Government, there is no excuse for continuing to kick this can down the road. It is time that we genuinely took action.
At the heart of this question, we need to establish to what extent the cost of care should be met by the individual and by taxpayers. We need to establish a consensus on the balance between those two. From my perspective, it is not fair that at the moment that cost is met almost entirely by individuals. Equally, it would be unfair for it all to be met by taxpayers when people have some assets. We therefore need to settle that question properly. I would also gently say that our politics has not been entirely honest about that. It is worth reminding the House that at the moment only £14,250 of capital is protected. As the hon. Member for Worsley and Eccles South mentioned, that means those with very long-term care costs, particularly those who suffer from dementia, can face catastrophically high bills. There are, therefore, very strong arguments for a cap.
There are other reasons why we have to grip this issue now. As the hon. Lady mentioned, local authorities cannot plan their long-term finances. That also brings a real threat to financial stability within local councils. It is fair to acknowledge the challenges within the care sector, too. Many providers are finding the marketplace challenging, not least because of workforce challenges, but also because local authorities are insisting on paying low rates for residential care. That brings with it an additional injustice—people who are deemed able to pay for their care find themselves paying higher rates for the same product than local authorities do for those who do not pay for their care. I think that is a major injustice in the system.
The issue is that local authorities are commissioning care from local care providers and paying the rate that the individual resident is incurring. It is about what they are prepared to pay for that bill and not the local authorities paying living wages directly to employees. However, that is pushing the risk on to care providers, and we need to acknowledge that there will be workforce challenges for those providers. They will be competing more and more for people. While there is that downward pressure from local authorities on what they are prepared to pay and the upward pressure on wages, the risk is being borne by providers.
Part of the solution is also not just about who pays. We need to be a lot more imaginative about this. We all know that we will live longer—beyond 70—and that we will have more years in life in retirement. Just as we make plans for our pensions, we need to make provision for our homes and how we are going to live in old age. The simple fact is that our housing requirements when we are in our 40s and are raising a family are rather different from what we might require in our 90s. We know that falls are one of the biggest burdens on the NHS, so the fact that we are not encouraging people to make sensible lifestyle decisions about their homes is causing additional cost to the NHS, as well as, potentially, the need for more long-term residential care. One reason why we have that issue is that we have allowed, collectively over decades, so much wealth to be stored in our housing stock that we have encouraged people to behave in a way that makes them want to cling to it. I would like us to look more imaginatively at incentives through the tax system to encourage people to downsize and look at different ways of living. We want to use the planning system to encourage the development of retirement villages where people can purchase extra care.
Some people like to care for relatives at home, and it is not uncommon to create a small annexe within or adjacent to the property for an older relative to be cared for, but currently, the council tax system means that if that relative passes on, after that—within two years—people will be charged double the council tax for that part of their dwelling. Does my hon. Friend think that that is something that we can improve on and change to encourage people who wish to look after their relatives in their properties to do so?
I completely agree. That is exactly the kind of incentive that we should encourage. The longer that we can encourage people to live independently, the better their quality of life and the better it is for the taxpayer, because there will not be those ongoing bills. The point is exactly that as we live longer, we will spend many years in a condition of frailty, and that needs to be properly managed through the system.
Every parent, with the best will in the world, will wish to hand on as much of their assets to their offspring as possible, but that could also encourage behaviours that are bad for their health. I want my parents to realise the value of their assets rather than protect their inheritance for me. I am sure that most people would think that about their parents, but there is a lot we can do on the tax system and incentives to encourage families to manage those issues collectively and in a way that is good for people’s welfare as they become elderly and enables them to do more for their children.
It is high time that we tackled this issue. We should also not look at this entirely in isolation from the issues regarding working-age adults, which are also a major challenge for local authorities as they manage their finances in this area. We must look at the issue of people with learning disabilities and autism being increasingly placed in areas of long-term care. The issue is that, although we have been broadly successful in moving out people with learning disabilities through the transforming care programme, sadly the pipeline afforded by those people moving out has been filled by people with autism. The Government have to give a much clearer challenge to commissioners. When faced with people with complex needs, the first instinct should not be to put them in residential care. Too often we have seen how those kinds of placements do harm. We need to challenge local CCGs and NHS England to put much better care upstream by providing early diagnoses for people with autism and giving them the tools to protect themselves.
On the workforce issues, surely the answer to the dilemma the hon. Member is describing is to have a professional, well-paid, well-trained workforce that can deal with people with the most complex needs in their homes and allow them to remain there as long as possible.
The key words the hon. Member just used were “in their home”. There is no public policy challenge that does not come back to having the right kind of housing solutions. Many of these issues arise from our not investing in the right kind of supported housing environments that would enable more people to live independently. That has to be part of the solution. Local authorities and the local NHS need to come together to commission the right kind of service.
As we are short of time, Mr Deputy Speaker, I will end there, but it is high time we gripped this once and for all.
We need three things to make our social care system fit for the future: access to good quality care for every older and disabled person who needs it; more support for families to look after the people they love; and better care jobs so that paid careworkers can afford to stay in work and support their families as they care for ours. I will take each in turn.
First, it is a disgrace that in the 21st century, in one of the richest countries in the world, 1.5 million older people are not getting the basic help they need to get up, washed, dressed and fed—that is one in seven of the entire population aged over 65—and that figure will rise to 2 million in a decade’s time unless the Government change course. It goes without saying that this is not good for the people who need support to perform the functions of basic daily living, but it is not good either for the taxpayer, as more older people end up going into hospital and getting stuck there when they do not medically need to be there, with all the knock-on consequences that has for hospital waiting times and NHS budgets. We have got to stop treating the NHS and social care budgets separately, because they are inextricably linked, and we have got to stop fixating on hospitals, because the care system of the future lies in the community and closer to home.
Secondly, we need to give more help to families. Many of the UK’s 6.5 million unpaid family carers face a desperate daily struggle to look after their older or disabled relatives. They often feel pushed to breaking point financially, emotionally and physically. One in three carers have to give up work or reduce their hours because they cannot get the help they need to look after their loved ones, so they lose their income, the economy loses their talent and the Treasury loses their taxes. How does that make any sense? We no longer think parents should be forced to give up work to look after their children, so why do we accept it for those caring for elderly or disabled relatives?
Many of us on the Opposition Benches believe universal childcare to be as much a part of our economic infrastructure as the roads and railways. That we are living longer means we need to see social care, too, as an essential part of our economic infrastructure. With so many people now looking after their elderly mums and dads as well as their own children, we need to be thinking about universal family care and leave to meet the realities of modern life, because families should never have to choose between holding down a job and caring for their own.
I ought to have declared that I am a co-chair of the all-party group on carers. I am pleased my hon. Friend has mentioned unpaid carers. The Secretary of State took 19 minutes to acknowledge the existence of the millions of unpaid carers in our society. I wonder if my hon. Friend has any tips for the Government for how they could address their needs.
Unpaid family carers need family-friendly working arrangements so that they can balance their work and caring responsibilities; they need an NHS that recognises that their own physical and mental health could suffer too, and they need to know that we are there to support them. Rather than criticising families and saying that they should be doing more, we should acknowledge that many carers have not had a break for weeks, months or even years. We have to change that, because this is not going to happen to somebody else. This is going to happen to every single one of us here.
Thirdly, we need better care jobs. Paid careworkers do some of the most important work in the country, looking after the people whom we love, but many struggle on low pay and zero-hours contracts, with high levels of stress and little training. No wonder staff turnover and vacancy rates are so high, although the vast majority of careworkers say they love the work that they do. We need a comprehensive strategy to improve the pay, professional development and employment security of care staff, and we desperately need to increase the number of careworkers too. We shall need more than half a million more careworkers in a decade’s time, not to improve the care system by providing better quality or wider access, but just to meet increasing demand.
That is why the points-based immigration system announced by the Government will be a disaster. If we already need more than half a million extra careworkers just to meet levels of demand, how on earth will we cope with that new system? It will not be possible. I beg the Minister to meet me, and others, to discuss the development of a separate route into social care in the migration system of the future, because otherwise we simply will not cope.
None of those changes—improving access to care, more support for families and better care jobs—can be delivered on the cheap, but the truth is that families, the NHS and our economy as a whole cannot afford for us not take action. We need, first, an immediate and significant injection of cash into the system in next month’s Budget, and, secondly, a long-term plan for investment and reform. Any new funding system must work for disabled adults as well as older people. It must strike the right balance between individuals and the state. I, for one, strongly believe that we should pool our resources and share our risks rather than leaving people to cope alone. The system must also be fair across the generations. I do not believe that the working-age population should pay for all the additional costs of caring for our ageing population Wealthier older people will need to make a contribution too.
Alongside this funding reform must be a change in the way in which social care is provided, so that it is not just about time slots and tasks simply to keep people alive, but about offering great support how, where and when people want it, so that they can lead the lives that they and their families choose.
This radical reform of social care is just one of the changes that we must make to meet the needs of our ageing population, which is one of the biggest challenges that we face as a country. We need to change our housing so that it helps people to live independently at home for longer. We need to reform the world of work so that, as we live for longer, we can work for longer and more flexibly. We need to change our health services so that they keep people fitter and healthier for longer as we live for longer. None of those things will be easy, but if we want to meet the challenge of our ageing population and if we want to make Britain the best country in the world in which to grow old, we need to grasp this nettle, and we need to do it now.
Thank you very much, Mr Deputy Speaker.
Devon is a wonderful place for people to come and retire, and as a consequence we have many older people. According to Age UK, we have 39,853 individuals over 65 who have unmet social care needs, and in my own constituency the figure is 3,614. We know that there is a problem. It is not just in my constituency, and it is not just in Devon. I think that there is already a strong chord of agreement in the House that this is no longer about talking, but about action.
Those listening will expect us to act for them. They will not expect us to get involved in political wrangles. We have already had political wrangles over Brexit, and look where that got us: three years of inactivity. This Government have a majority, and with that comes a responsibility to finally resolve this social care problem. We have to find a solution. No more reports. No more royal commissions. We have had Sutherland, Wanless and Dilnot, and no Government who commissioned any of those reports have accepted all their recommendations. What would be the point of another one? The Care Act 2014 was a great start, but part two has not been implemented. Frankly, I do not think it ever will be. The reason? It is not affordable. Certainly, how we would afford it has not been thought through.
What is the barrier to all this? Why do Governments of every colour fail to deliver? First, there is a reluctance to ’fess up and actually admit how much this is going to cost. Secondly, there is disagreement across the House as to exactly how that cost can be met. We have already seen examples of that in the contributions today. Even if we could agree, there are other things that need to be sorted out, as my hon. Friend Jackie Doyle-Price mentioned. We need to agree as a nation on the standard of care that should be delivered. We are not there yet. Even LaingBuisson, which has set many of the standards, has not done that.
We need to accept personal responsibility to maintain and improve our own health. We do not yet do that. We need to reduce our own care needs, or at the very least delay them. We need to consider developing community resilience. Families are often widespread, and we need to take responsibility for our neighbours and plan together for our wellbeing. We need to drive forward a wellness and wellbeing agenda, which is much more a public health agenda. Too much time is spent on illness, and not on wellness. We need to change our mindset with regard to old age, and I would certainly recommend reading “Extra Time: 10 lessons for an ageing world” by Camilla Cavendish. Being old does not necessarily mean that we are past it and falling off our perch.
What is the roadmap to change? For me, first, we need to define what “good” looks like to the recipient. Secondly, we need to decide what resources we need to provide that. Thirdly, we must develop a proper training and recruitment plan, and motivate our staff. Fourthly, we need to evaluate the adequacy of the existing infrastructure for care delivery. Do we have the right model? No, I do not think so. The earlier references to housing were well made in that regard. Fifthly, we need to look at integrating not just health and care but the whole IT strategy and housing strategy. There is much more work to be done on that. Sixthly, we must bite the bullet and decide which of the nine funding models—because there are nine—suggested in the various reviews we are going to use. There will be a degree of mix and match, but we have to make a decision.
So, that is for the long term. In the short term, we need a fix, and it is not just about money. We need to ask the Care Quality Commission to set the minimum funding levels that we will expect local government to pay for the care of any client, and central Government should be obligated to pay for that. We must make local authorities accountable for both the quality and quantity of care provided. They are not at the moment, and we know that there is a bit of a postcode lottery. We must make the NHS and local authorities equally and jointly accountable for the health and care delivered in the home and in care settings. That is not the case now. I do not ever want to hear a clinical commissioning group telling me, when it is talking about closing one of my local community care hospitals when we have no nursing care in the area, that it is not the CCG’s problem but the problem of the local authority. That is not acceptable, and it is not responsible.
We also need to put in place a full review of nursing care outside NHS provider institutions, and provide ring-fenced capital funding to deal with it. We need to stop the practice of putting people who should be receiving nursing care into residential care homes. That is not responsible; it is not right for the care home or for the client. We must stop caring for dementia patients in hospitals. That is completely wrong. It is not right for their care and not right for them in the long term. We need to create the right provision.
I am afraid that we also need to increase general taxation and report annually as to how that money, which should be ring-fenced, is being spent. I believe that those who are working should carry on paying national insurance contributions even past retirement. I take the point about the older generation who have retired contributing, and that needs to be taken into account. We should raise the level of personal funds that an individual may keep before they contribute. I think it should be raised to £100,000, and we need to cost that. We need to include more people with lesser care needs in the state-funded system, and, as has been discussed, we need to develop a funding model with the private care sector and the insurance sector that combines personal and state contributions to care costs, looking at compulsory savings and risk-sharing mechanisms.
We have made a promise to the British people, and we must keep it. Now is the time for action. No more talk, no more reports and no more commissions. This is the time for this Government, who have a majority, to deliver.
As I was preparing for this debate, I looked at last year’s debate and, as other hon. Members have said, it was like we have not moved on at all. We are repeating the same arguments, and nothing has really changed. What has changed, however, is that we are seeing increased demand for social care, whether domiciliary or residential, but local authorities’ ability to deliver that support is decreasing because of financial pressures.
Demand is continuing to rise. Age UK says that 1.5 million people aged 65 or over have an unmet social care need and believes that that could rise to 2.1 million by 2030 if the current approach continues. Last year, over half of the 1.32 million new requests for social care resulted in no services being provided. In my constituency, Age UK tells me that 3,012 older people have unmet care needs, and that 2,517 older people are providing the care that family members require. Of course, we must also recognise that thousands of unpaid care workers are providing support to people in their homes, and we must never forget that. I salute them for carrying out that essential work.
I will reiterate some of the points covered in the previous debate, because they remain central to this debate on social care. We need more money. We do not need the drip feed of a 2% increase in council tax, which in constituencies with a low council tax base, such as mine, will not produce anything near the money we need, compounding inequality and injustice. We need a substantial increase, and Age UK estimates that an increase of £8 billion is required over the next two years to stabilise the current system while we look at what will be provided in the future.
We need to look at the market for social care providers. The market is fragmented at the moment in both residential and domiciliary care, and most authorities have seen providers fail in both areas, meaning that they need to step in as an emergency measure to ensure that people get the help they need. We cannot continue with a market based substantially on price competition, because local authorities are forced to look for the lowest bids. We need quality services that deliver the things that people require and deserve. I would like to see more directly provided social care services, because that gives us control.
We must now develop a workforce strategy for social care. We have talked about that a lot in relation to the NHS plan and the future workforce strategy, but we need to look at it here, too. The social care workforce is predominantly female. They provide the most personal and intimate care to the people we love, and we must recognise the value of their work. They need proper pay. They need professional registration, which people working in the sector are considering. They need improved training and development if we are to recruit and retain the staff we need. We must put an end to carers travelling in their own time, to zero-hours contracts, and to 15-minute visits, which all of us would agree are completely outrageous.
My hon. Friend mentioned the very personal nature of the care provided by prepared carers, but young carers also do this. They allocate medicines, and they even take their parents to the toilet or wash them. Does she agree that so much more needs to be done to recognise the role of young carers and to give them even greater support?
I certainly agree that we must recognise the work of young carers, who do a tremendous job. We place huge pressure on them, and we thank them for their work. We must look after them, too.
We need a workforce strategy, and there is much more I could say. Others have already touched on the high cost of care for those with dementia, as opposed to a physical illness, and we need to do something in both the short term and the long term. We need a long-term, thought-through plan for providing social care to all those who need it.
We need a plan for social care that supports people when they need it and that cares for people when they need it. It should not just look after them mechanically; it should care for them. The Prime Minister said during the election that he has a plan. Well, let us see it and debate it, because we all know this action is long overdue.
I support the Government’s amendment, particularly the line about seeking cross-party consensus. Opposition day debates may not be the ideal time to seek consensus across the Chamber, but consensus will be vital in the long term.
Governments of all stripes have tiptoed around this problem for 20 years because no credible solution is painless for everyone. It is expensive, emotive and, for those of us who have seen the current system close up through our family, often very painful, but there have clearly not been enough of us to make solving the problems less painful than allowing them to drift on with regular injections of emergency funding, which are of course welcome, but they are a sticking plaster.
To have a long-term solution, we need all parties to agree, as they have on pensions—another long-term, expensive, complex issue on which we do reasonably well as a country. Even in these divided political times, people of good will can work together across parties.
We have heard a lot about the overall problems of staffing levels, wages and the capacity of the system to cope, all of which I agree on. The vast majority of people agree that we need to spend more. At the same time, they insist that they should not pay any extra tax themselves. We need a serious conversation about this. It is easy to present solutions for those who do not accept there is a bill.
We know that social care, especially for the elderly, is often too opaque for those trying to understand it, with no apparent logic in the conditions that receive free NHS treatment and those that do not. It is also apparently unfair in not rewarding a lifetime of prudence. Those who have saved feel that their savings will simply disappear, while those who have not saved receive the same level of care, often in adjoining beds.
Less well known is the fact that funding social care out of council tax means local authorities are too often reluctant to allow new care homes to be built. An ageing population means that already more than two fifths of council spending goes on social care. That figure will only increase over the years, so councils are understandably fearful that all their other services will be swamped by the rising demands of the social care system. That is not sustainable in the long term.
Of course, all the various failures in the social care system put unnecessary extra pressure on the NHS. Indeed, the long-term plan, with all its generous funding for the NHS, depends on an assumption that we develop a social care system that keeps people out of hospital longer and discharges them faster in a smooth and timely fashion. At the moment, both halves of that assumption are questionable, as others, such as my hon. Friend Jackie Doyle-Price, have said. We need to solve the social care problem to solve the NHS problem as well.
A new system needs five objectives. Interestingly, I listened to the speech from Liz Kendall and my list does not differ hugely from hers, which suggests that a cross-party consensus is possible. First, a new system needs to provide enough money to cope with the increasing, ageing population. Secondly, it needs to be fair across generations, meaning that today’s working taxpayers are not asked to pay both for their own care in decades to come and the care of the generation above them. Thirdly, it needs to be fair between individuals by ensuring that no one has to sell their own home for care and ending the dementia lottery in which one condition is treated on the NHS and another is not. Fourthly, it needs to lead to an increase in the supply of care beds and retirement housing. Fifthly, in an ideal world it should establish a long-term cross-party consensus.
We need to look to the pension system as a model, because it has achieved many of our aims. In recent years, the state pension has been increased significantly, but at the same time most people save additionally throughout their working years to provide comfort and security in old age. Auto-enrolment has been a great cross-party success story. Similarly, just as the basic state pension has been improved, we should offer a better universal care entitlement, with a better level of care for both home care and residential care. Needs would be assessed locally, but crucially the money would come from central Government rather than local government.
We also need to encourage people to save themselves through a care supplement—a new form of insurance designed specifically to fund more expensive care costs in old age. The analogy is with the private pension system, allowing people to buy insurance at a level that they can afford to provide peace of mind. It would not be compulsory so could not be stigmatised as a death tax or dementia tax.
The ideas I have outlined would take the burden of social care funding away from local councils and, even more importantly, offer certainty and security to the increasing numbers who will need social care in old age. No one would have to sell their house and see their whole inheritance disappear; everyone would have the chance of receiving better care; and fewer people would be left unnecessarily in hospital beds as they wait for social care to be available. None of this is easy and it will take political courage, but it is absolutely necessary if we are to provide peace of mind and security to frail, elderly people and working-age people who need care. They all deserve it.
It is a great pleasure to follow Damian Green. I found myself agreeing with many of the priorities that he set out; that gives us some hope about cross-party consensus.
I wish to talk about three things: first, the proposal by Derbyshire County Council to close the Spinney care home in Brimington in my constituency and six other homes throughout Derbyshire; secondly, the wider implications of Government funding decisions over the past 10 years; and finally, the role of carers and the impact of councils’ use of private sector agencies to reduce council budgets on the quality of care provided.
First, the Spinney is a care home built in 1974 and run by Derbyshire County Council. Up until the Conservatives took over in 2017, it had been rated good by the CQC and was full; since 2017, the council has stopped taking new residents, and gradually numbers have fallen as residents have passed away. All the residents and their families to whom I have spoken speak warmly of the quality and culture of care provided by the Spinney and oppose the council’s call for closure. In the past two years, five of the rooms in the Spinney have been fitted with en suite bathrooms—the lack of en suite facilities being one of the reasons given for the closure—but none of those rooms has been used. Now, Derbyshire County Council says it will close the home and allow the residents to live more independently.
The comments from residents make it clear what they feel. One said:
“I have no relations, no family, the carers and staff are my family…I want to live the rest of my days here it has all come crashing down around me”.
“People will not get more than 10 minutes three times a day” if they leave and go independent. They went on to say that
“this doesn’t stop people roaming the streets and the police having to bring them back.”
A family member said:
“My mum lived independently till she was 96 years of age. We all rallied round to look after her, but she was only safe once she was here at the Spinney.”
There are many, many more stories.
I note that the county council had a £5.7 million underspend last year in its social care budget, so I roundly condemn it for its decision, and I hope that it listens to reason when the consultation finishes and that it agrees to improve the Spinney rather than to let it close.
More broadly, we all know that the money available to councils for social care has been savagely cut during the nine years of austerity. Indeed, at the very time when our ageing population were demanding an increase in care spending, the Government were cutting £5 billion from council budgets for care. The money that the Prime Minister has promised, welcome as it is, is simply one step back up the mountain.
The failure to provide care for some of our most vulnerable citizens is not just morally repugnant and does not just shame us as a society, it is also economically illiterate. Failure to care for people in residential or domestic settings and leaving them to fend for themselves means that they end up in A&E. It means that they end up being treated more expensively in our hospital system. The 148 people who were left in hospital beds in Derbyshire because there was no care package available for them were costing us more than they should have done as a result of cost savings. Cuts in care are not only barbaric, but economically crazy too.
There is no way that a Government who have reduced council spending by 50% in real terms over 10 years can be anything but complicit in the care crisis that faces us, but providing ring-fenced money for care alone will not be the step required to make this right. There must be a whole-system approach that addresses the many causes of the crisis in care. Those causes include the inadequate number of GP appointments available, particularly in more deprived areas; the crisis in the recruitment of GPs, nurses and carers; and the casual and unprofessional way that carers are recruited, trained and employed, which means that workers at McDonald’s are given greater job security and better rates of pay than someone who plays a crucial role in the health of the most vulnerable citizens in our society. There is also the crisis in A&E, which sweeps up the greater share of the NHS budget. That crisis is then exacerbated by people taking up hospital beds when they could be at home receiving care, and so the vicious cycle continues.
Finally, I would like to touch on the issue of how carers are employed. Council budgets are a part of this equation, but, in truth, councils were outsourcing these services long before council budgets were shrunk. It should never be said that people who provide care on behalf of private companies—or, in many cases, those companies themselves—have any less capacity to care or any less empathy for their customers than people who do it in the public sector. However, many councils are signing tenders that can only lead to the provision of inadequate care.
Hillcare Group, a nursing care home provider in my constituency, wrote to me recently to say that the funding provided by Derbyshire County Council was £150 per resident per week less than in other local authority areas, and that ends up having an impact on the care that is provided. I have an idea: when councils set tenders, they should be setting a rate of pay at the time they use private companies. The reason for using private companies is not just about saving budget, but about that company providing care in a better way. It is not just a way of undercutting the wages of unionised council staff. If rates of pay across the sector were set by the councils, we would not find council contracts being provided by private companies in such an inadequate way.
This is a multifaceted and real problem. Residents and families of the Spinney are just the latest victims of our failure to take this matter seriously. I hope that it will be solved, because our older people desperately need it to be.
It is a pleasure to follow Mr Perkins and all the other contributors. There seems to be cross-party consensus that we need to find a solution for all our constituents. I welcome the new Care Minister to her place. We entered the House together, and I know that this subject is a real passion of hers. I am very excited that she is in post, and I think we can expect great things from her in this area of reform. I also thank her predecessor, my hon. Friend Caroline Dinenage; on the day that the chairs were rearranged, she was in my constituency opening a new hospice, and she was absolutely wonderful to all the staff and patients.
It is a delight to speak in this debate, because this issue is the key concern in my constituency, as it will be in many constituencies. We talk about the fact that 18% of people across the UK are over the age of 65, and that that figure will rise to just shy of 25% of the population by 2040. But in my constituency, 30% of constituents are already over the age of 65. That is absolutely fantastic because we are rich in seniority, but it does mean that there are people who have difficult needs and challenges. In a constituency such as mine, people tend to retire down to the coast and downsize, which means they live in smaller properties and pay much less council tax. However, they also tend to need more services from the local community. It is for that very reason that we cannot continue with the concept of council tax funding social care. It is a postcode lottery, and the places that need the most are given the least when it comes to yield.
I would like to see the system centralised, but rather than having another NHS system, we should inject a bit more reform and interest. That is why I said to the Secretary of State that it would be right for us to follow the German model. In the ’90s, Germany had the exact same issues that we have today, with regional imbalances meaning that parts of the German republic just could not afford social care at a local level. There was also great unfairness in the country because certain people just could not access the care that they needed, and it would wipe out their assets. Both parties then fundamentally agreed that it was in the interests of all their constituents to work together on a cross-party basis to deliver reform. That was when the policy of long-term social care insurance funds was established.
The German model requires individuals to pay in. No individual pays more than €138 a month, and the employer matches that amount. Retired people pay the full amount themselves, so the policy gives a nod to intergenerational fairness. It takes risk out of the system; if one individual has greater needs than another, that is not factored into the amount they pay. Crucially, it has been popular. People do not talk about social care as a political issue in Germany in the way that they do in this country.
In a way, this situation is an absolute tragedy. Opposition Front Benchers rightly talk about the years that we have had in Government in which we could have fixed the issue, but they do not focus on what had gone on since 1997. The Labour Government absolutely ducked this issue and were faced with calls from the Conservatives of “death tax”. In return, we got that back in spades when we talked with honesty in our 2017 manifesto and proposed a policy that was then labelled the “dementia tax”. Our constituents—all of us, across the House—must absolutely despair.
I will give way to the hon. Lady, because a couple of years ago when I made the point that I hoped we could work on a cross-party basis, the talk back to me was, “Actually, that cost you the election, and we wouldn’t work with you on that basis.” I found that response rather frustrating, so I hope for more.
I do not recall that I ever said that, but there is a key point in what the hon. Gentleman is saying. Our recollection is that it was not the Labour party that labelled the Conservatives’ proposal the dementia tax. I think it was actually one of the national charities and the phrase then got taken up by the media, so I ask the hon. Member not to pin that one on us. It is important that we establish cross-party talks, but the people he should be addressing his comments to are on his own Front Bench. Ministers have had since October to follow up on the point I raised with the Secretary of State about cross-party talks, but they have done nothing. We keep hearing about cross-party talks, but they are not happening because the Government are not doing anything about it.
I remember well the exchange that I had with the hon. Lady a couple of years ago. The point I was making was that we did not seem that far apart—she talked about the fact that more funds needed to be raised, and so did we, perhaps with people taking individual responsibility—but the response I got back was more like a lesson on why such policies cost us our majority. That may have been a fair point, but my frustration was that we were being honest and straight with people that if we actually want to reform the system, we may need to ask people to pay more in. Most people do not realise that they already have to pay for it; it is only when they access the service that they fully understand what it really costs them. A lot of people—about 50% of the population—think that the NHS takes care of social care for them. They do not understand.
Whenever we try to propose reform around election times, it turns into a political football. In a way, this is the time to have the conversation, because I do not believe there will be an election for many years to come, so there is the opportunity for us to work cross-party. The hon. Lady is absolutely right: for cross-party talks to occur, she needs a proper invite, and I very much hope that that will be forthcoming. However, given that we now have a Conservative majority, in the event that, sadly, these cross-party talks do not work out—as I say, I hope they do, because that is the greatest chance we have of delivering reform and persuading the public that we are all in this together on their behalf—then I very much hope that we will use our ideas, our mission and our majority to put reform through rather than saying that it has faltered because we cannot get consensus.
The most vulnerable, the elderly and the people who have worked hard all their lives are now lacking in dignity within the system because we simply do not have enough money in place. We have not delivered the reforms that we talk about in this place constantly but still fail to enact. I very much hope that this Government will do that, hopefully on a cross-party basis, but if that does not reach fruition, then by inputting our own principles, our own policies and our own devotion to the people I am talking about, so that we give them and the generations to come a better future.
We cannot overstate the scale of the social care crisis in this country. The Government continue to kick the proverbial can down the road, with the Green Paper promised in March 2017 still not having materialised, and much of the public conversation focuses simply on the issue of funding. Clearly, I do not wish to diminish the urgency of the need for greater funding, but without fixing all that is structurally broken in social care, any increase in funding will not necessarily flow through to care quality or care workers’ wages, where it is desperately needed.
First and foremost, we must look at the skills and professionalisation agenda in social care. I urge all colleagues across the House to read the report from the last Parliament by the all-party parliamentary group on social care co-chaired by my hon. Friend Louise Haigh and Gillian Keegan. It made some very important recommendations in this area, particularly about registration and the lack of qualifications that are transportable across the health and social care sectors. Addressing this will, in turn, create an upward pressure on wages, and give people more pathways to development and progression so as to make a career in care more viable, reducing the turnover in the sector. The pay differential between a new care worker and someone with years of experience is only about 17p per hour. This cannot continue.
We must urgently look at the issue of the fragmented provider landscape and outsourcing, which is one of the key drivers of low pay in the sector. Only yesterday I was forced to write to a local provider about its proposals to reduce the terms and conditions of former council workers outsourced to the company. Private firm Catalyst Choices, which has been providing care services for Warrington Borough Council since 2015, is proposing cuts including, but not limited to, a reduction in weekend enhancements, overtime pay and sick pay. I do not want to single out this provider because I understand that this problem is replicated up and down the country owing to chronic underfunding by cash-starved local authorities. However, it is forcing people out of the sector. In my constituency, every time the Trafford Centre advertises for temporary workers, we see a knock-on effect in local care. When Amazon opened a distribution centre in Warrington, that triggered a crisis of care provision locally. What does it say about how we value our care workforce that a company with a reputation for poor pay and exploitative work practices is considered preferable to remaining in social care?
This workforce crisis in care is evidently having a really detrimental impact on the provision of care, as we cannot get quality care on the cheap. Shortages of care workers locally mean that too many elderly people in the villages of my constituency are having to stay in hospital because they cannot get a care package to support them back in their homes.
While we must develop an effective workforce strategy for our care workforce, working with care providers and the TUC on a real sectoral plan, we must also ensure that the challenges faced by our unpaid carers are properly recognised. We have 6.5 million unpaid carers in our country. Despite the additional costs of caring, the lack of practical support means that carers often contribute their own money to care for their loved ones. Despite the significant costs and the value of care that they provide, the main benefit for people caring—carer’s allowance—is the lowest of its kind, at £66.15 per week. It is not nearly enough.
Until we start to properly recognise and reward care work, whether it is formal or informal, paid or unpaid, we will never have a system that provides the quality of care that everyone deserves. This Government can no longer dither and delay on one of the biggest crises we face as a society, and the problem grows more severe with each passing day as the issues that I have outlined go unaddressed. Before coming into Parliament, I worked for a trade union and used to speak to careworkers, who told me that they were frightened to retire, because they know what is waiting for them when they need care. That is a sobering thought on a future that we need real action now to avoid.
To begin, I would like to declare a couple of interests. My partner owns a communications consultancy that works in health and social care. Both my parents were nurses. My father managed residential nursing homes until he retired, while my mother was a deputy sister in a residential home, caring for people with dementia.
I would like to focus my remarks on those who work in social care and what we might do to improve the recruitment and retention of staff. In my mind, much of it lies in the value we attach to those who work in the profession. Many of my constituents work in social care, and the profession is just as important as our NHS in helping to support our community. Those working in care homes and in the community across my city and the country should know that they are valued, just as we value our hard-working doctors and nurses. I know how hard the staff in care homes work each and every day. It is often a job that goes without much reward. Pay can be low, and recognition is often lacking, but it is critical.
The National Audit Office estimates that 1.3 million people do these jobs. The Centre for Workforce Intelligence has suggested that an extra 660,000 careworkers will be needed by 2035 if we are to keep pace with demand for care. When we consider that more than a third of staff switch jobs or move out of the sector each year, we begin to see the challenge. Those are worrying figures for families who rely on this service. Why do we have a problem with recruiting and retaining social care staff? Pay is clearly a factor, but it is not the only one. Too often, the profession is held in low esteem, which makes it difficult for some providers to recruit and retain staff.
I am pleased that the hon. Gentleman has used the word “profession” several times, because this is not only about training and qualifications but about status; that is a very important factor. I bang on about money for low-paid workers all the time. Does he agree that professional work deserves professional pay, not minimum pay, which the majority of careworkers seem to be on?
I accept what the hon. Gentleman says —pay is indeed a factor in the recruitment and retention of social care staff, but I also agree that it is not the only factor. Terms such as “low-skilled worker” are far too commonly used in relation to care staff. That language and perception need to be challenged. We need a greater emphasis on professional structures, career development and appropriate reward.
We also need to celebrate these roles and show how rewarding and fulfilling they can be. After all, this is about looking after people. These people are our grandparents, our fathers, our mothers, our uncles, our aunts and, in some cases, our children. One day it is likely to be us. I will never forget a constituent telling me about his job in social care. He said that each and every day, he got to look after, talk to and listen to people who became his friends, and he felt he was almost cheating by calling it work.
I agree with the hon. Gentleman in my professional capacity as a GP. It is invaluable to have people who know those they care for: they can pick up when there are problems, and they can inform professionals. Does he agree that we need this kind of relationship—people who understand the people they are caring for—because it saves the NHS money? That is not in any statistic that we may see, but that professionalism, dedication and care make the real difference not only to the person but for the wider NHS.
I agree entirely with my hon. Friend. Those social care staff and the relationships they have with the people they care for can save our service money.
Don’t get me wrong. Social care is hard, sometimes literally requiring heavy lifting and involving emotional distress, yet it is a career that can be rewarding. The Government are keen to build the same consensus on social care that already exists on our national health service, and that is the right thing to do. I hope that we can build parity of esteem for our social care workers.
Of course, there are millions who undertake social care roles without any pay. I listened with great interest to some hon. Members’ comments about unpaid carers. The 2011 census—obviously some time ago—identified that one in 10 residents in England and Wales, or 5.8 million people, are spending at least part of their week caring for disabled, sick or older relatives and friends. As with careers in social care, carers can often enjoy their work and it can be positive and rewarding. There are, however, a lot of reasons why carers need support. Carers’ own health and wellbeing problems are often exacerbated or caused by their caring role. Carers are entitled to a social care assessment of their own needs, and subsequently support, if the assessment shows that they need it; but not enough carers are being identified and subsequently assessed, and that means that they are going without support for their needs, putting their own health and wellbeing at risk. Support for carers should be embedded in funding for social care, and evidence shows that supporting carers can save money in adult social care services and the NHS, while improving the life of the carer and the person with care needs.
I would like to make a quick mention, if I may, of the social care work that goes on in my constituency. Some of the most enjoyable time I spent on the campaign trail was at two hustings that were organised in Peterborough. One was the general election hustings for adults with learning and social disabilities. I found it one of the most rewarding aspects of that campaign, because I learned a huge amount about the experiences of those particular constituents and of those who care for them. I would like to pay tribute to Klayr Lynch, the facilitator of Club 73, and her team for all the hard work they undertake each and every day for some of my most vulnerable constituents. They do a truly brilliant job. The same can be said of the disability hustings organised by Disability Peterborough and the Cambridgeshire Deaf Association, organised by my old school friend Andrew Palmer.
Colleagues will learn much about social care from their own constituencies. In this place we rightly often talk about hard-working doctors and nurses. Understanding the crucial work that those in social care undertake, may I make a plea that hon. Members, especially my right hon. Friends on the Front Bench, remember to include a reference to social care workers when they talk about hard-working doctors and nurses.
In June this year, it will be 10 years since the Dilnot commission began its work to look at long-term funding of the care system. That anniversary also marks 10 years of Tory austerity and 10 years of abject failure on social care, during which time the cuts to local council budgets, combined with the growth of our older population and an increase in the number of working-age adults living with support needs has created a full-blown crisis in our social care system. It is a crisis that is being lived out day-to-day by the 1.5 million people who are eligible for support but not receiving any and by the families fighting for the support that their loved ones need. It is an utter disgrace that people with learning disabilities and autistic people are trapped in hospitals and care staff face intolerable pressure for too little pay. Careworkers are low-paid, but they are not low-skilled. The crisis in our care systems will be deepened by the loss of highly- skilled workers from overseas as a consequence of the entirely misplaced points-based immigration system the Government have just announced.
I was a member of the Select Committee on Housing, Communities and Local Government in the last Parliament, and it was striking that the number of councils, of all political persuasions, including Tory-run county councils such as Kent and Somerset, describing a crisis in their ability to deliver on meeting the social care needs of their local communities with the resources they had available kept growing with every call for evidence the Committee put out. Faced with this crisis, affecting millions of families every day, the Tory manifesto simply promised cross-party talks. We have had a decade of cross- party and independent work on this issue, by Select Committees in the Commons and Lords, by Sir Andrew Dilnot, by many different all-party groups and by the Local Government Association. The challenge of social care is quantifiable and quantified: £3.5 billion just to meet current needs; and more to deliver a system that can guarantee dignity for everyone who needs support. The menu of options to provide this funding is also known. The Government cannot keep prevaricating. Now is the time to bite the bullet and act to solve the crisis.
As co-chair of the all-party group on adult social care, I attended a meeting yesterday with about 150 stake- holders from the social care sector: social workers; carers; and people receiving care, who are experts by experience. We heard about many examples of good practice in care. There are carers going above and beyond the call of duty every single day to deliver excellent person-centred care, but we also heard about the intolerable pressures. Where social workers are assessing someone in the certain knowledge that the funding is not there to deliver the support they need, that is an unacceptable and unsustainable compromise of their professional practice, yet it happens every day. The care sector is desperate to get beyond the conversation on funding to a discussion about the detail of a care system that can deliver dignity and the highest quality of life for everyone who needs support; and how we make co-design and co-production the basis of all social care delivery, recognising that people who need care and support are as diverse as the wider population at large.
The hon. Lady is giving an excellent speech. She is putting forward a proposition for a co-produced model of care that is integrated with health, housing, and community care and services. Does she agree that substantial progress has been made in the past four years on that in Scotland? I say that in all honesty; it is far from perfect yet, but we are on the road to a far more inclusive, cohesive system. Does she agree that the Government might want to discuss this with the Scottish Government to see what lessons can be learned?
I thank the hon. Gentleman for his intervention. I agree that in many parts of the country, including Scotland, there are examples of good practice from which the Government can learn.
We need a system that recognises the individuality and diversity of people who need care. We need one that recognises that mental health support needs are completely different from physical needs, and that everyone who needs support will have a different version of what a good day looks like for them. We cannot get to that conversation until the funding is there to deliver such a system and until the workers in the care sector are properly paid, with access to training and career progression. The Government are playing a completely cynical game with social care, offering council tax increases, which hit the poorest hardest and raise only a fraction of the funding needed, and offering in this Parliament less than a third of the funding required just to meet current needs—and just for one year only.
In the meantime, delayed discharges from hospitals are going up, care homes are continuing to close and care companies are continuing to hand back contracts to councils. Millions of people are left with care that does not fully meet their needs or are having to fight to receive any care at all. The Equality and Human Rights Commission is taking the Government to court over the failure to properly house autistic people and people with learning disabilities. This is unprecedented and it is a disgrace. All of this places intolerable pressure on the relationships that keep the care sector going, the value of which is never captured on the public sector balance sheet. The Secretary of State spoke today with bravado about the current situation, but with no emotional intelligence about the day-to-day reality of the broken system that his Government are meting out or the urgency with which this crisis must be fixed. He will not give confidence to those who rely on the system every single day, and to those who work hard to deliver care, with the approach he is currently taking.
We have good-quality social care provision in Bury, and have been ranked among those at the top in Greater Manchester for a number of years. The clinical commissioning group and the local authority work hard with external providers, with a supportive approach to quality assurance. This ensures that CQC ratings for our provider market continue to be good, and have focused on building positive relationships with them. This quality approach impacts positively on the health system too, as Bury has the second lowest admissions to hospital of older people in Greater Manchester. That means admissions are avoided, which is better for both the person and the public purse.
The integration of health and social care in terms of both delivery and commissioning is being embraced in Bury, and is really important to provide a holistic approach to people, their carers and families. Bury has created a local care organisation, with £19.2 million of Government money. Integrated neighbourhood teams are a key part of delivery for people in neighbourhoods, bringing together social care, community health and primary care. This approach avoids duplication and gives streamlined services to people. This, coupled with a preventive approach, along with population health improvement priorities, is the long-term answer to demand in the NHS, in my opinion.
Greater Manchester devolution brings together local authorities and the NHS in terms of community leadership and frontline delivery. This is very different from the rest of the country, where CCGs are merging to create strategic transformation partnerships on huge footprints. This local approach in Greater Manchester recognises the significance of the wider determinants of health in managing long-term health issues. However, in my opinion, the lack of a long-term funding solution for social care is the Achilles heel. Council tax solutions are not the answer. For example, places such as Bury, which has a faster-growing older population than the rest of Greater Manchester and therefore greater health needs in the long term, are unable to raise the amount of funding needed locally.
The national living wage—an excellent concept, if unfunded—puts additional pressure on councils’ social care budgets, since they have to pass on uplifts that reflect the pay rates of the people delivering care. This does create significant financial issues in the social care system, in what is already a pressurised set of services, due to the demands from the numbers of people and the ageing population, which, as I say, is growing faster in Bury than in the rest of Greater Manchester.
As we have heard, the workforce is as big an issue, if not bigger, for social care as for the national health service. Although the news about the increasing number of nurses is welcome across the health and care economy as a whole, those working in the private provider sector of social care have been overlooked in recent announcements, and recruitment and retention may therefore be even more difficult than they are already.
The final point I wish to make is that temporary funding, even when relatively long term through the better care fund and the improved better care fund—this year, it has provided £18.5 million of funding to my local authority—is not helpful for a system that is demand-led and has to ensure that it provides value for money wherever possible. A more certain and improved settlement for social care would ensure that longer-term planning can be put in place.
I am pleased to speak in this debate as a serving councillor still on Luton council, because we know how much social care needs are impacting on local councils. We have heard much from many colleagues, but I want to bring a bit of lived experience to the debate.
Luton council set its budget last week, but we have been struggling, like many councils up and down the country. Our revenue support grant has been cut by about £100 million since 2010. We have made £130 million-worth of cuts and efficiencies over that time, but we are facing rising demand-led service pressures, predominantly for the vulnerable, especially in children and adult social care services.
But as social care demand rises in our communities the Government are hamstringing the capabilities of councils such as Luton to deal with the pressure by slashing central funding. We cannot expect local councils to deliver social care without the necessary funding. Allowing councils to raise the adult social care precept to 2% does not satisfy the rising financial pressures facing many councils, and it shifts the responsibility on to individual council tax payers without taking into account their ability to pay.
Councils such as Luton, which has a low council tax base due to 80% of our properties being band A, B or C, cannot raise enough tax to meet the demand. A 1% rise in council tax equates to about £700,000, so the maximum of 4% is around £3 million, but the Luton council budget has faced growth pressures of over £7 million in adult social care and children services. So as these demands increase, our ability to meet that demand diminishes. Fundamentally, there is a structural deficit there.
One thing I want to talk about in terms of lived experience is being at the frontline as a local councillor; I want to bring that to the Chamber so that Members here can understand what is happening on the frontlines. For two years I had lead responsibility in the public health commissioning arena as a senior councillor, and we worked very closely in jointly commissioning services with our CCG. Ultimately, I want to praise council staff, CCG staff and health staff providing both domiciliary and nursing care, as well as those working in other social care settings, for all the hard work they do supporting people in my constituency. As has been raised by other Members however, there is a difficulty in that councils are insisting that we only pay certain rates for the provision of care. So we are forced into desperately looking at what prices are to provide care, rather than looking at the whole picture, wanting to provide good-quality, safe and compassionate care. I put the fault for that fundamentally on the Government and the crisis they are putting local councils in.
One of the things we often had to do was look at the provision of the market of social care in our town. It pains me to talk about a market in providing care; it should be a service, publicly provided. However, we are in the situation we are in, but we struggled sometimes with some service providers beginning to fail, and therefore as a council we had to step in and support them, which meant having to bring in better providers, which obviously charge more. That put increased pressure on our budgets, meaning there is a never-ending cycle when we are being significantly underfunded.
There are plenty of other points I could raise, but most of them have been made by fellow Labour Members, so I want to finish my contribution to this debate by recognising all those who provide care to elderly family and friends as unpaid carers, such as my friend Barbara. She spent the last few weeks caring for our friend Ray, who died on Sunday morning. He did not have any family, and he did not live in a house that he could put an annexe on; he lived in a one-bedroom council bungalow. And Barbara, who in the day had a full-time job working in social care, still went to see him every evening to make sure he had the additional support and dignity that he needed. So I spent much of Sunday supporting Barbara because she was sad that he had passed away and she was not there. But, luckily, in the care home where he spent his last few days, the nurse sister who was on that shift was with him. So I praise everybody, whether they are working in social care or like my friend Barbara who was looking after Ray unpaid, because they are bearing the brunt of this crisis and it is not right.
I pay tribute to Rachel Hopkins for making such a powerful speech.
I want to talk a little bit about technology, but before I do so, I just want to make a quick point. We talked earlier about an ageing population and the word burden was used a few times. I just want to send a message from the Chamber to anyone who is a member of the older generation. They should never feel that they are a burden. People using the social care system should never feel that they are a burden on the system. It is the older generations who built the foundation on which we now stand. They are the generations we should care for because they cared for us. They are the ones who enabled us to have the lives we lead and the freedoms we have, so I do not believe that the word burden should ever be used in relation to older people.
One of the challenges in society—I have talked about loneliness in the Chamber before—is the isolation that people can feel. When it comes to caring, there is an ongoing sense of isolation for both carers and those being cared for. The trouble with that is not just the challenges around social care—how to reach people, how to visit them or how to get nurses or doctors to them—but a real loss to society. What we lose by isolating older generations in particular is their wisdom. It is the stories of their lives and the passion they had once that they may now feel has been diminished. The opportunity we have through social care is not just to fix bones or mend injuries, but to release those stories. The stories people share enable us, as a society, to be stronger through the lessons they have learned in their lives.
That is important to me, because of one aspect not often talked about when we talk about health generally, and social care in particular: the role of technology. Technology is not just there for us to Google an answer or share a tweet. It can also be there to connect the dots. The lifeblood of the beating heart of society is in the charities and organisations that go out and help, and in the people who really care for others. One challenge is to ensure that we do not lose those interconnections. Before Christmas I went out with a fantastic organisation, Small Acts of Kindness, run by Lynne Misner, which helps people who are struggling with loneliness and the drop in temperatures and who need blankets. Another amazing lady, Margaret Hudson, cooks for the lonely and isolated on Fridays in Watford.
I mention them, because they are all little dots across the whole of Watford and the country that we are not connecting. There is an opportunity here for us to use technology in a different way. Businesses increasingly use data to create a single customer view, which connects the dots of customers in the private world so they know what they are buying, where they are sharing content, what they are talking about and what they are interested in. Sadly, in the private world that is used for advertising. However, we can look at the social system and the NHS in the round, and start to look at people not in isolation—whether they have broken a bone, had a fall, where they live or how old they are—and connect the dots so that we can start to say, “How do we look at them as human beings and look at their life stories, and what that might mean for how we predict what might happen to them.” Somebody with the onset of arthritis in their in their 60s no doubt has the potential to get worse in their 70s, 80s and 90s, so why do we not start to plan early on?
We should therefore not just look at technology, the social care system and data in isolation. We need to look at pathways for people as they get older, so we can start to predict how injuries might happen and what issues might come up. We can use that information to create a more cohesive society, so that everybody who touches that person’s life in some way can feed into it and make a difference. The idea of watching people might sound like a scary big brother moment to some, but if we do it in the right way, we will save the economy millions, if not billions, because we will have predicted things and prevented them. We will also have made life better for so many more people in our community.
Let us work together. Let us not put up political barriers and be isolationist in how we look at the world and challenge the problem. Let us work across the House. Let us put people before politics. Let us make sure that together we make a better country for anybody who needs social care. We can make a real difference together. In four or five years’ time, the whole of the electorate will benefit. More importantly, society will benefit too.
I speak from the experience of having run adult social care services in a community centre for the last three years in Battersea and of being a serving councillor in Wandsworth Borough Council. I want to explain something that may have been missing from the debate up to now and make the case for community services as part of our social care system.
The social care system is in crisis, as Members on both sides of the House have acknowledged. People across Putney, Roehampton and Southfields raise this with me all the time and many people who do not raise it with me, I know, are suffering in silence, trying to find the care that they need or that their adult child, family member, friend or parent needs. The social isolation of elderly people and adults who need additional support is increasing while care services are decreasing. Last year, there were 1.32 million new requests for social care, only half of which resulted in a service being provided. For the other half, nothing was provided or they were signposted elsewhere, often to overstretched community services.
A national care service is needed that joins up health services, social care and community services as a third but essential pillar of this, bringing us together. I agree that we must do it by working together, as has been mentioned, but we must build stronger communities and work together for the good of all. It has been so frustrating to run older people’s services for the last three years while, all around us, it felt like the council-run services were decreasing and the health services and the NHS were providing less and less. We were being left to pick up the pieces yet we were not being provided with either the funding or the way of organising our care service that enabled us to do that.
Across the country, funding for council’s adult care services has dropped by 50% in the last 10 years since the Tories came into power. The whole system is so disjointed that it is really hard to function within it. Community organisations, staff and volunteers spend lots of time chasing services and making relationships with different professionals and organisations who then move on, and we have to start all over again. There urgently needs to be a plan that joins up the NHS, social care and the voluntary sector. This is about funding, but there needs to be far more—it is about organisation and putting adults, the elderly and their needs at the centre of the decisions that we make, rather than organising to make things easier.
Too often, as I said, the voluntary sector is picking up the pieces. Fantastic local organisations such as the one that I worked in, the Katherine Low Settlement, but also Putney-based Regenerate-RISE and the over-60s lunch club—I am sure that hon. Members know of many in their constituencies—are providing long-term support, not piecemeal support. There is an understanding of people’s whole community, including their family, their friends, and who is caring for them, as well as a much quicker speed of response, which really understands the changing needs of the vulnerable in our society. They are also great value for money.
Too often, however, the voluntary sector is not even mentioned in a debate such as this. It is treated as the last on the list and as not being professional. It is often treated with disrespect, whereas from my experience, community services are often on the cutting edge of care for adults with special needs and the elderly. We can learn a lot from such services and they need to be part of the plan that we hopefully will create.
Community services can respond really quickly. Assessments by social services often take months and in that time, an elderly person’s health can deteriorate because they are not getting the care they need. That can end up being a greater burden to the local authority than if support had been put in place earlier, and it can lead to a prolonged stay in hospital.
Last year, 2,000 people died every day while waiting for a decision on their application for social care—it is almost unbelievable. The provision of care for older people is diminishing and the problem of older people living longer is growing. The number of residential and nursing home beds has fallen in every region of England in the last five years. For instance, the care for people with dementia—that long-term, increasing and changing support—is often best provided by community care services. Social workers often change their roles frequently, so older people are faced with people they do not know and who do not understand their situation, whereas community services can provide long-term continuity and culturally appropriate care.
I pay tribute to all the social workers and careworkers across the country who do amazing, selfless and dedicated work and yet are not valued. As has been said, there must be a new system of pay, training and qualification that values our careworkers, who are too low paid but certainly not low skilled. I also pay tribute to the 6.5 million unpaid carers. Often, the only support they receive is from community services, and it is that which enables them to support the people they are caring for. By co-commissioning with health, social care and the voluntary sector, we could give people the best chance of staying at home and not going into care. We need a national care service that places equal value on community social care services alongside health and social care. We need better ways of working, better funding and, ultimately, a better quality of life for everyone.
I am pleased that Labour has chosen this important debate as one of its Opposition day topics. Social care impacts on people from all backgrounds across the whole country, and it is right that we continue to debate it, so I hope that we can seek some consensus and look for a cross-party solution to this issue, rather than turning it into a political football. It is simply too important for us to treat it in any other way. I also pay tribute to those working in the care system, both paid and unpaid. It can be a tough and rewarding job, as my hon. Friend Paul Bristow said earlier.
One area of agreement should be to welcome the positive steps the Government have taken in recent years, including the more than £10 billion in additional funding since 2017; the introduction and increasing of the social care precept; and the increases in local authority core spending power. Clearly, though, there is much to do, as we have heard this evening. I am glad that my party recognised this fact in its manifesto last year and is committed to a long-term solution. I hope we can all agree that any solution must not be one that forces vulnerable people to sell their homes to pay for care. We cannot overstate the challenge ahead. As the Secretary of State said, in 40 years our population will have grown by 10 million. If that was all working-age people, perhaps it would not be an issue, but over half that growth will be among the over-75s. This group will have more than doubled in size by 2060.
In the same period, the number of over-65s requiring round-the-clock care is expected to rise by a third. Among over-85s, that figure will double. Serious conditions, such as dementia, diabetes and obesity, are also on the rise. They only seek to aggravate the issues, especially among the elderly. The kind of care required by people suffering from these conditions—dementia, in particular—is the most expensive and needs the most intervention. This, though, only covers half the issue. We must remember that social care is about not just the elderly but working-age adults and children. According to the House of Commons Library, local authorities spend as much on under-65s as they do on over-65s. These statistics help to illustrate just how challenging the issue will be and highlight how important it is that we work together to find a long-term solution.
In the meantime, there are small but important steps we can take to help. Lapis Care, a care provider in my constituency, is holding a community care show in Wycombe on
This is a tough issue that we have to sort out, but I welcome more discussion of it, and I really enjoyed listening to the other contributions to the debate from Members in all parts of the House.
A hugely fragmented provider landscape has been one of the major problems in the social care sector. Hundreds of providers are operating in some areas, and most councils have experienced provider failure or the return of contracts. The Government’s fears about providers going out of business may explain their reluctance to clamp down harder on companies that are failing to fulfil their minimum wage obligations. Britain’s four largest privately owned care home operators have built up debts of £40,000 per bed, which means that their annual interest charges alone absorb eight weeks of average fees paid by local authorities on behalf of residents. Despite that, HC One, the UK’s biggest care home operator, has still managed to pay out more than £48 million in dividends in recent years.
A report produced recently by the Centre for Health and the Public Interest demonstrates just how much money is allowed to leak out of the social care sector in the form of, for example, profits, rent and interest payments, with the level of leakage far higher among for-profit providers. Any funding boost for social care must therefore be accompanied by meaningful reform of the sector which moves away from the failing markets and, instead, embraces a vision for care that puts a public sector ethos and core ethical requirements at its heart.
As we heard earlier from my hon. Friend Liz Twist, a critical part of social care must be to produce a workforce who are fairly rewarded and properly valued. Careworkers have been absent from much of the discussion about implementing the NHS long-term plan and developing the final NHS people plan, although the future vision for the NHS is one that brings health and care closer together. As the House of Lords Economic Affairs Committee pointed out:
“The care workforce needs a career structure which better reflects the skills required to be a good care worker and the social importance of the sector.”
The Nuffield Trust recently stated that
“a realistic and comprehensive workforce strategy is needed to combat the chronic recruitment and retention crisis that that is affecting the social care sector.”
Recent work by the Institute for Public Policy Research has begun to point the way towards the development of a workforce strategy for the sector, with a focus on proper pay, professional registration, and improved training and development. Working in care needs to become an attractive career choice if social care is to shed its unwanted reputation as a low status, high turnover sector. My trade union, Unison, recently launched the Care Workers for Change campaign, which calls for a real living wage as a minimum, fair contracts, no zero-hours contracts, and enough time to care and a safer working environment for our incredible careworkers.
I sincerely hope that cross-party talks are constructive and meaningful. I therefore ask the Government to enact meaningful market reform of the social care sector that moves away from the current landscape of fragmented providers, and to develop an effective workforce strategy so that staff are fairly rewarded and properly valued.
Let me begin by welcoming the new Minister to her post. I sincerely hope that she enjoys her time in the role, and that at some stage in the future she will be able to look back and see herself as the Minister who truly transformed social care. That transformation is desperately needed, which is why we called today’s debate. I think it has been a thorough and thoughtful debate on both sides of the House.
We have had 16 Back-Bench contributions, including from my hon. Friends the Members for Leicester West (Liz Kendall), for Blaydon (Liz Twist), for Chesterfield (Mr Perkins), for Warrington North (Charlotte Nichols), for Dulwich and West Norwood (Helen Hayes), for Luton South (Rachel Hopkins), for Putney (Fleur Anderson) and for Liverpool, Wavertree (Paula Barker), as well as from Damian Green and the hon. Members for Thurrock (Jackie Doyle-Price), for Newton Abbot (Anne Marie Morris), for Bexhill and Battle (Huw Merriman), for Peterborough (Paul Bristow), for Bury North (James Daly), for Watford (Dean Russell) and for Meon Valley (Mrs Drummond). I also want to pay tribute to all who work in our social care services, whether they work in the national health service, for our local councils or for an agency, and whether they are paid or unpaid carers.
This is the third time I have closed an Opposition day debate on the crisis in social care. Someone on the Conservative Benches said earlier that they had a sense of déjà vu, and I have that same feeling myself. Just as I said last time in my closing comments, we have still seen no plan from the Government, despite the Prime Minister using his very first speech at 10 Downing Street to pledge to solve the social care crisis. I want to remind the House just what he said:
“I am announcing now, on the steps of Downing Street, that we will fix the crisis in social care once and for all, and with a clear plan we have prepared to give every older person the dignity and security they deserve.”
We have seen nothing. It is now 1,079 days since the Government announced their Green Paper on social care. That is 1,079 days in which we have been told that the Government have been working on their plan for social care. However, only a couple of months ago the Minister for Women and Equalities and Trade Secretary, Elizabeth Truss was asked:
“Does the Green Paper actually exist?”
She shook her head and told the room:
“Not as far as I’m aware.”
After years of promises and failure to deliver, we can understand why many within the sector have very little trust in this Government, so will the Minister please clear this up now? Was the Trade Secretary misinformed, or was the Prime Minister not correct when he told the country that he had a plan for social care? If it is the former, surely the Minister will appreciate our concern that the Minister for Women and Equalities and her office have not been involved in the development of a policy that will impact on so many disabled and vulnerable people who depend on care, and on the predominantly female workforce who deliver it.
The Prime Minister might speak of levelling up as though he were playing a computer game, but his lack of action is having real impacts on real people. It is a national scandal, and the Government should feel ashamed that 1.5 million people are now not getting the necessary help to carry out essential tasks such as washing and dressing themselves. Millions are suffering because nobody cares for them. One in five people have gone without meals because of a lack of care. One in five people have been unable to work because of a lack of care. One in five people feel unsafe moving around their home because of a lack of care, and more than a third are unable to leave their home because of a lack of care.
This neglect does not only hurt those who need the care. As my hon. Friend the Member for Leicester West set out, and as my hon. Friend the Member for Luton South said when she spoke so passionately about Barbara and Ray, it is important to remember the 7.6 million unpaid carers who have stepped up to look after family and friends. One of those people, Frances from Harrogate, told the Care and Support Alliance:
“Dad has now passed away but his needs, with two broken hips and pneumonia, were not met in the slightest by either the NHS or social services. I feel if care had been better he would still be alive. Mum is in a care home and I have had to give up my job to care for them and I have received very little acknowledgement of this.”
At the very least, I hope we will hear from the Minister today how she plans to give unpaid carers the support they deserve.
We are yet to hear a Minister properly acknowledge the scale of the crisis. Instead, we heard once again from the Secretary of State in his opening speech the Government’s claim that they are addressing the problems in the system by investing £1.5 billion into social care this year. That has to be shared between adult and children’s services and winter pressures, and it is one tenth of what this Government have cut, according to the Health Foundation. In 2018, the Local Government Association warned that the funding gap for adult social care alone would grow to £3.5 billion by 2025, and the LGA revealed yesterday that pressure on children’s services has pushed overspending to £3.2 billion over the past five years.
We also know from LGA research that the new funding will not even be enough to cover the increasing costs that will come from the rise in the national living wage from April. Unfunded increases in the national living wage in social care have been shown by the Low Pay Commission to lead to an increase in failing businesses, insecure working conditions, and a reduction in care quality. Professor Martin Green, chief executive of Care England, has called on the Government to take responsibility for this situation, saying:
“If government fails to support this uplift then services may close, jobs will be lost and support to people in need will be reduced at a time when more people need social care. The social care system has endured chronic underfunding for many years and we call upon the government to fund not only the increases in the Living Wage, but the sector’s long term sustainability.”
Instead of the Government taking responsibility and recognising the scale of this crisis, their recent immigration announcement threatens to make it even worse. I endorse the words of my hon. Friend the Member for Leicester West, who said that we need to recognise the value of migrant labour to the social care services on which our constituents rely. Care roles fall below the salary threshold. The Minister knows that. The Government’s reluctance even to fund the costs of the increases in the national living wage does not give me much hope that they will fund the obvious solution—valuing and paying careworkers more for their vital work. It was worrying that the Home Office’s policy statement outlining the new migration policy failed to mention social care.
Councils led by all parties are facing a funding crisis, with devastating effects on key public services for children at risk, disabled adults and vulnerable older people. The services we all rely on, such as clean streets, libraries, children’s centres, street lighting and pavement repairs, are being cut back to pay for those people-based services. This is not a party-political issue. The issues are self-evident. In the recent state of the sector report by the Local Government Information Unit and the Municipal Journal, only 3% of councils said that they are happy with Government progress on local finances and only 2% said that they were happy with the Government’s work on social care. That is near-universal disappointment from council leaders and chief executives. Seventy-six per cent. said that they lack confidence that the Government are taking this problem seriously and prioritising a solution.
The Government’s delay is already costing lives. Last year, 2,000 people a day died while waiting for a decision on their application for social care. That should shame us all on whatever side of the House we sit, and there is only so much longer that this sector can wait.
This is the reality. Unless this issue is given the attention it demands, more councils will fall under financial pressure, more social care providers will fail and more of the most vulnerable people we are all here to represent will go without the support they need. It cannot go on like this. We need a plan, and I commend this motion to the House.
I am delighted to be here at the Dispatch Box as Minister for Care. I thank the shadow Minister, Andrew Gwynne, for his welcome, if not for everything else he said. I hope we will be able to work together on fixing social care.
I am aware that my new job comes with great responsibility. I am mindful of the many thousands of people who rely on social care and of all the challenges in our current care system, but with that responsibility comes an opportunity to take forward changes that we know are so desperately needed now and for the future.
Before I say any more, I pay tribute to the countless carers, social workers, nurses, friends and family members who care for people in this country. Their dedication means that so many people who need help receive it. Our social care system is utterly dependent on their skills, compassion and hard work.
The Minister is generous in giving way.
I visited Goyt Valley House care home in New Mills on Friday and saw at first hand the amazing work done by the staff. I spoke to the relatives and residents and learned just how important the care home is. Unfortunately, its future is currently in doubt. May I invite the Minister to come and visit New Mills and see the care home for herself?
I have already visited two care homes since becoming Minister for Care, and I want to visit many more. I hope I will be able to take up my hon. Friend’s invitation and see that good work for myself.
I pay tribute to my predecessor as Minister for Care, my hon. Friend Caroline Dinenage. I hear that she was visiting a hospice on reshuffle day—her actions illustrate the enormous commitment and compassion she brought to this role. I sincerely hope to follow in her footsteps.
I also thank all the hon. Members who have spoken today. Social care is important to many thousands of our constituents, and their interest and input are incredibly valuable.
I welcome the Minister to her post, and I welcome what she says about carers. Would it not be wonderful if, rather than just giving them her warm words, support and admiration, she were able to join a cross-party campaign to see that carers get paid more than burger flippers in McDonald’s so that we actually start recognising them with the same prestige as nurses and the same earnings as people in our health service?
I thank the hon. Gentleman for his suggestion. It is almost as if he has seen my notes.
One thing I particularly welcome is the number of hon. Members on both sides of the House who spoke about the importance of careworkers, who provide such important care.
My hon. Friend Paul Bristow mentioned that both his parents were nurses in the care sector. He drew on his knowledge of care and rightly said that the profession should be held in higher esteem and that, just as we hugely value NHS staff, we should hugely value careworkers. The hon. Members for Warrington North (Charlotte Nichols), for Blaydon (Liz Twist), for Dulwich and West Norwood (Helen Hayes), for Putney (Fleur Anderson) and for Liverpool, Wavertree (Paula Barker) and my hon. Friend James Daly spoke along the same lines, and I could not agree more.
Not long after I became the Member of Parliament for Faversham and Mid Kent, I joined a careworker, Kim, on her daily round. By the time I met her at 7.30 am, she had already started washing her first client. By lunch time, she had washed, dressed, fed, medicated and chatted with six or seven men and women. Some of them were grateful and some of them, quite honestly, were not grateful, but they were all utterly reliant on her care. That experience really brought home to me the skill, knowledge and compassion of our social care workers. For those who need help, there are amazing carers with hearts of gold, like Kim.
Our care system depends on an extraordinary workforce of capable and compassionate carers, but we need more people to choose care as a career. That means changing the perception of being a care worker. As a society, we must truly recognise the importance of the work. We must make sure that more people realise the range of jobs in care and the opportunities for progression. The Government are currently investing in an adult social care recruitment campaign with the strapline “When you care, every day makes a difference”. We are working with Skills for Care to support workforce development and there is funding for a workforce development fund. That is really important, but we know that we must go further in making sure that we truly value the important work that the care sector does and to make sure that the care profession attracts the workforce that we need and gives them the opportunities to lead a truly fulfilling career.
Several Members rightly talked about unpaid carers, who also provide so much vital care. We fully recognise the value of that work and know the importance of support for those people who do so much caring. That is one reason why the Government will introduce a statutory right to leave from work for one week a year for the 5 million people who juggle work alongside being an unpaid carer.
My hon. Friend the Member for Bury North talked about quality of care, and it was really important to hear that mentioned as part of the debate. He spoke about how good care is in his constituency, and he is absolutely right that we should talk about how good care is throughout England. Some 84% of adult social care providers are currently rated good or outstanding by the CQC. Let us recognise the high quality of care.
My hon. Friend also spoke about the importance of integration—of the NHS, local authorities and care providers working together—as did my right hon. Friend Damian Green, who is knowledgeable on this subject. The interplay between the NHS and social care is critical. The better care fund and the improved better care fund are a success story in respect of enabling more co-operation between the systems. It is crucial that we continue to build on that success so that our care system meets the needs of the individual, not just of the system.
My hon. Friend Dean Russell made some excellent points about how, paradoxically, we can use technology to help to achieve more human and more personal care for a more cohesive and effective care system.
Both my hon. Friend Jackie Doyle-Price and the shadow Minister for Care, Barbara Keeley, mentioned those with learning disabilities and autism who are being cared for in in-patient settings. I am new to this job, but I absolutely appreciate the importance of making sure that we do better in this regard. People should be cared for in the best place for their needs. At the end of last month, the number of those in in-patient settings had been reduced by 24% compared with 2015—
At times this has been a heated debate, but I heard on both sides truly constructive suggestions for how we can solve our social care challenges. That gives me much hope for cross-party consensus. I heard suggestions from my hon. Friends the Members for Newton Abbot (Anne Marie Morris) and for Meon Valley (Mrs Drummond), my right hon. Friend Liz Kendall and my hon. Friend Huw Merriman, whom I thank for his kind words welcoming me to my job. He set the bar high for me to meet.
I am fully aware of the challenges that face our care system and I have no illusions as to the scale of the challenge facing us. In the next 10 years, we expect the number of people over 75 to go up by 1.5 million, and the number of people under 65 with care needs is growing, too. We have a system that is under pressure and the demands are only going to grow.
In the spirit of being constructive, let me mention, as I did during my speech, the huge and rising pressures on social care. There are 120,000 vacancies here and now. We need more than half a million care workers in a decade’s time just to keep up with rising demand—that is not to improve the system, but just to keep pace with demand. The proposed points-based system of immigration will be catastrophic for social care. Will the Minister meet me and others who work in this area to explore the potential for a separate route into social care, so that we can avoid further pressure and worse care for the people for whom we love and care?
What I would like to emphasise in response to the hon. Lady’s point is the importance of our recognising, valuing and making sure that social care is an attractive career. In that way, those who are already working in social care will continue to work in social care. It will be for us to build the workforce that we need for the future.
I am conscious of time, so I must now come to my conclusion.
We all bring our experiences to our work, and, as I conclude this debate, I want to mention one of mine. When my grandmother was 100 years old, she was admitted to hospital and she stayed there for five months. She was signed off as ready to leave numerous times, but each time the failure to find a care package delayed her discharge, during which time she would acquire an infection, further delaying her discharge. She was eventually discharged, but only in time for her to die—thankfully, peacefully at home. This is a cycle with which too many people are familiar, and it means that our hospitals are looking after people who would be better off at home.
As I have said, I am under no illusions about the challenges that we face in social care. The problem that I have just described is nothing new, but let us be the generation that solves it. That is a commitment that we as a Government have made. We will fix the crisis in social care. We will deliver the funding that is needed now to stabilise the system. We will find a long-term solution to the growing need for care and seek to build a cross-party consensus on this. We are committed to the view that the prerequisite of that solution is that no one needing care will have to sell their home to pay for that care.
We will not be supporting the Opposition’s motion tonight, but where I think we can all agree is on the importance and the urgency of reform of social care. As we bring forward those plans, I look forward to working with colleagues from all parts of this House. Just as we had a consensus in the 1940s on the NHS, the time has now come for a new consensus on social care. Let us be the generation that works together and makes our care system work for all those who so badly need it.
Question put (
The House divided: Ayes 181, Noes 315.
Question accordingly negatived.
Question put forthwith (
Question agreed to.
The Speaker declared the main Question, as amended, to be agreed to (
That this House notes that the Government is committed to fixing the crisis in social care; and supports the Government’s commitment to find a long term solution for the growing need for care and commitment to an ambitious three point plan, including extra funding every year, seeking a cross party consensus and ensuring the prerequisite of any solution is a guarantee that no one needing care has to sell their home to pay for it.