My Lords, I should like to speak on the Care Bill, which, as my noble friend Lord Hunt has stressed, is recognised as an important step towards providing a consolidated legislative framework for our social care system based on the excellent report from the Law Commission, which we established to streamline and unify social care law. The Bill implements 66 of the commission’s 77 recommendations, refocusing care and support on more patient-centred services that are better suited to people’s lives and needs, with well-being as the guiding principle. We strongly support this; it takes forward our work on patient choice and control, builds on the progress we made in key areas such as prevention, personalisation of services, carer recognition and support in our landmark National Carers Strategy. It also addresses many of the “unfinished business” issues that we proposed in our 2009 national care service White Paper.
Like other noble Lords. I commend the pre-legislative scrutiny work of the Joint Committee. The Bill, as seen in the stakeholder evidence to the committee, enjoys considerable support among patients, carer organisations, staff, service users and providers, with, of course, the key proviso that major improvements are needed to address what the committee itself identified as the “gaps” and “risks of unintended consequences”, and the wider issues relating to both the NHS and social care. For all the widespread support, however, the gentle language of a cross-party report expressing the committee’s concern that the Government,
“has not yet fully assessed the scale of change the Bill will bring about”,
speaks volumes. It is a message that we on these Benches, along with care and support organisations across the statutory, private and voluntary sectors, have been trying to hammer home since the draft Bill was introduced. It is not just about the “new costs” impact of the Bill itself that were cited by the committee, such as those resulting from the huge increase in the number of care assessments under the new capped system; the Government also need to recognise the scale and urgency of the current care crisis and that their proposed Dilnot solutions need to extend to self-funders, the millions of people with limited means and those who are unable to pay for adequate care and support.
The Government know that the proposals will not stop people having to sell their homes to pay for care, will not cap the costs that elderly people pay for residential care, and will not mean that pensioners get their care for free if they have income or assets worth up to £123,000. From the outset, we have underlined our concerns that unless the new legal framework is introduced in the context of also addressing the current and future social care funding problems, it runs the danger of raising expectations and demand that cannot be met, and will be ineffective and inoperable. This view is underlined by leading stakeholders, including Age UK and the Care and Support Alliance. Council care budgets are being cut to the bone, with the latest figures from ADASS identifying a further £800 million squeeze on social care budgets over the next year. I know that the noble Earl insists, despite all the evidence, that local authorities have sufficient funds to meet the current demand, but this is just not so.
London Councils is a cross-party organisation representing 33 London authorities. Its recent report, A Case for Sustainable Funding for Adult Social Care, based on financial modelling by Ernst & Young, researched the scale of savings that could be achieved through greater efficiencies such as integrating services, implementing alternative delivery models and making major changes to care delivery and procurement. Even with maximum savings and before the introduction of any form of Dilnot implementation, the Government would still need to increase London’s adult social care budget by potentially £1.1 billion to meet increased demand. Labour supports the principle of capping care costs, but we stress that a bigger and bolder response is needed by the Government to meet the challenges of our ageing population. Whole-person care is our vision for a 21st century health and care system that brings together physical health, mental health and social care in a single service to meet all a person’s care needs. Our independent commission has already started its work on looking at how health and social care services’ budgets can be brought together so that integrated services do not mean just a series of area or service-specific initiatives and pilots, but a way of working for a whole service. We have a major task ahead of us to improve the Bill, and Labour pledges its commitment to work hard to make sure that older and disabled people and their families get the best possible deal.
On carers, the House should note that the need to ensure their well-being is particularly underlined in the report of the Royal College of General Practitioners, which was published this weekend. It finds that 40% of carers are at risk of depression and should be regularly screened for this to ensure that their health needs are not neglected. We see a similar picture in the recent survey by the Stroke Association, Feeling Overwhelmed, which shows the potentially huge emotional impact of stroke on both survivors and their carers. The Bill is an important step forward in the development of carers’ rights, their recognition and the support they need, which we strongly support. In the coming weeks, it will be important to keep in mind just what demands we already make on carers. Some 7 million people currently provide carer support to a disabled or sick child or adult who otherwise could not live independently in the community.
As a carer myself, I am about to go through, with my partner, the final push under Surrey Council to convert all social care clients with long-term health conditions to self-directed support. We have a 46-page assessment form to complete, a host of supporting leaflets and briefings to read and absorb and, of course, a website, which I am sure will make us even more confused. This considerable task and commitment is the same for both self-funders and people receiving local authority support. Most frequently, it will probably be the carer who has to do most of the work, bear most of the responsibility and, probably, be most aware of and concerned about the potential effects if services and care packages are changed or, worse, withdrawn. That is certainly true for carers such as me, caring for a stroke survivor whose aphasia makes it difficult for him to read and understand forms and documents, and impossible for him to complete them himself.
Having said that, and to end on a positive note, the good news is that my experience so far is overwhelmingly that self-directed, personalised support and this approach to identifying future care needs for the cared-for and the carer is the right one. We need to ensure, as we work our way through the Bill, that the focus of the assessment is on well-being and support, and not on cutting back care packages that are generally working well and have taken many months and years of persistent effort to build up.