My Lords, as the Care Bill announced in the gracious Speech will have its Second Reading next week, like some others I have decided to keep my powder dry today and focus only on why the Bill is needed, not on its content.
Your Lordships will know that there is nearly universal agreement that the social care system is not fit for purpose. It was set up originally for a country where men died shortly after they retired at the age of 65 and women died before they were 70. The new statistics showing that, for example, 11 million people who are alive today will live to be 100 are cause for celebration, as is the fact that people are living not only longer but with greater degrees of disability. However, this also means that we are spending inadequate amounts on care and support, both publicly and privately. Social care funding has totally failed to keep pace with demographic change. Since 2004, spending on the NHS rose by £25 billion, but spending on social care rose by just £43 million—or 0.1% in real terms.
We all know what local authorities have done to cope with rising demand and static resources—they have increased charges for social care and rapidly raised the eligibility criteria. The percentage of councils providing support to those with moderate needs decreased from 50% in 2005 to 18% in 2011 as the eligibility criteria have been raised to cover only those with substantial or critical needs. This has been compounded by local authority spending reductions, with social services directors reporting £1 billion-worth of cuts to services in 2011-12 and warning of even greater cuts to come.
Public provision in this area is largely seen as providing poor services for poor people, and the media all too often give us distressing examples of that. However, anyone who works in this field must also acknowledge that good care is provided to individuals within the system because of the dedication and skill of thousands of workers. There are pockets of great service to be admired and we should always remember that. In general, however, the system is perceived to be starved of cash; failing to meet the volume of need; and unfair—a lottery, especially for people with middle incomes—for the simple reason that if you die neatly without needing to use care services you pay nothing while if you happen to have an illness or condition such as Alzheimer’s, you may need expensive services for many years, costing thousands, perhaps hundreds of thousands, of pounds. The system is also regarded as extremely confusing and difficult to find your way around.
These problems will only get worse if nothing is done. Within 20 years, the number of over-85s will double and the number of people living with lifetime disabilities will grow too. Relatively fewer people will be working and paying taxes to help pay for support. However, apart from the practicalities of money and how it is to be paid for, there are other changes in society that affect what we can expect from social care. People want greater choice and control than is offered by our current system and expectations about the standards of care are rising. It still comes as a shock to the average user of care that there is so little integration and such poor communication across health and social care systems—still less, as we have heard today, across housing and transport—regardless of the fact that people’s care needs do not come in discrete packages but are stretched across the whole of an elderly person’s life including their housing, their families and their income.
What happens when people’s needs for social care are not met? We all know what happens—they turn to the NHS. This results in increased demand for unplanned and emergency services and delays in hospital discharge. Your Lordships will have seen and heard all the publicity about pressure on A&E services recently and the conflicting views about both the cause and what should be done about it. These extra pressures of course come at a time when the NHS is already under severe financial pressure.
It is easy to be extremely gloomy about the problems in social care. However, we may have some opportunities now, principally in the Bill in the Queen’s Speech, to deal with some of them. The Government are to be praised for bringing forward a Bill which is intended to address some of the problems that I have set out by looking at the Dilnot commission and the Law Commission’s proposals and, perhaps very importantly, by defining the purpose of social care and how it is delivered.
The enactment of the care and support Bill will not just consolidate and streamline into a single statute 60 years of piecemeal law-making; it will place on a statutory footing for the first time both the principle and the practice of self-directed personal care based on individual assessment. Particularly pleasing to me is that the well-being principle is also to be applied to the individual’s carers. However, it cannot be denied that, taken together with the introduction of a capped system of funding and a national eligibility threshold, the Bill represents a significant implementation challenge for everyone with a stake in the care and support system.
Like other Members of your Lordships’ House I had the privilege of serving on the Joint Committee which gave pre-legislative scrutiny to the care Bill. We called many witnesses and received huge amounts of written evidence. Two themes were paramount. The first was the need for more integration, and the announcements today about integration between health and social care are very welcome indeed. The second was the need for more resources. Everybody was concerned about the inadequacy of the resources. I am sure that we will spend many happy hours debating that as the care Bill proceeds.
I hope that in the course of our discussions we will be able to give attention to some of the ideas that were set out in the report Ready for Ageing?, which has already been mentioned and was produced by the committee led by my noble friend Lord Filkin. It states very plainly that the welfare state was predicated on full employment and a brief period of retirement. Now, however, centenarians are common and a third of life may be spent in retirement, and yet pensions and social care continue to be organised on 1950s models. The report calls for, and states that there is a desperate need for, a national strategy that includes a radical reconfiguration of health and social care. The budgetary split between them is no longer sustainable. They must be commissioned and funded jointly so that resources can be better used.
All of this is a terrific challenge. However, it may also be the clearest call that we have ever had for a new vision for social care—indeed, for a different settlement for the older people whom we will all become. We certainly need a different vision and, by the way, more recognition of the contribution made by older people themselves. Let us not forget that 60% of childcare is provided by grandparents. Let us think also of the huge numbers of older volunteers. These are important political issues that we are actually going to have to address.
The Bill that we will consider gives us an opportunity to put a welcome focus on social care—always, thus far, the poor sister of the NHS. It will also give us the opportunity, if not to implement this new vision, then at least to consider and discuss it.