Adult Social Care - Statement

– in the House of Lords at 2:39 pm on 2nd December 2021.

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The following Statement was made in the House of Commons on Wednesday 1 December.

“With permission, Mr Speaker, I would like to update the House on our plans for adult social care.

Today we are publishing our ambitious 10-year vision for adult social care—our White Paper: People at the Heart of Care. It is a product of years of work, not only by every level of government, but by many involved in the sector, including people who give care, people who draw on care, and their families. I wish once again to underline my appreciation and admiration for everyone who works to deliver this most vital of public services, especially through this challenging pandemic.

Those working in social care—both paid and unpaid—deserve our deepest respect, yet they also deserve a system that works for them, and it is fair to say that that has not always been the case. Time and again, we in this House have heard about the challenges: the high turnover in the workforce; the lottery of how people pay for care; unsustainable local markets; the varying quality and safety of care; the low uptake of technology; those carers who are not just unpaid, but under-appreciated; and the complexity of the system for everyone involved. I am sure honourable Members will have their own challenges to add to that list. Make no mistake, these are complex issues—so complex, of course, that successive Governments, over decades, have decided to duck rather than deal with them. This Government, however, are determined to get it right. After all, we cannot be serious about levelling up unless we are also serious about social care.

In September we took a vital first step on the road to fixing this generational problem when the Prime Minister, the Chancellor and the Secretary of State announced our new health and care levy. The focus on how we must pay for it is absolutely right, but we were clear then, and we are clear now, that there is much else we need to do. The White Paper contains more detail on what we plan to do over the next three years to transform the sector over the next decade. It is underpinned by three core principles: first, that everybody has choice, control and support to live independent lives; secondly, that everyone can access outstanding personalised care and support; and thirdly, that adult social care is fair and accessible for everyone who needs it.

The principles we hold are important, but we know we will ultimately be judged on our actions. I will therefore set out some of those actions before the House. First, giving everyone the choice, control and support to live independent lives requires both physical and digital infrastructure. We are investing £300 million in housing. That investment will support local authorities to increase the range of new supported housing options, because it is vital that people live in homes that meet their needs and give them the independence they require. Moreover, we are setting up a new practical support service to help people with minor repairs and changes, which will help them to live independently for longer. That is in addition to increasing the upper limit of the disabled facilities grant for home adaptations, which includes things such as stairlifts, wet rooms and home technology.

The digital infrastructure we put in place can be equally transformational, because we know that digital tools and technology can support independent living and improve the quality of care. We are therefore putting in at least £150 million of funding to drive the greater adoption of such technology, with the ambition to achieve widespread digitisation across social care. We are setting up a new national website, which will explain all the upcoming changes, and we are piloting innovative new ways to help people understand and access the care and support they need.

Our second principle is to ensure outstanding personalised care and support, and at the heart of that is looking after the people who work in care. We are spending at least half a billion pounds on the social care workforce over the next three years. Some of those funds will help us to deliver new qualifications and better career routes in care, which we know is crucial for holding on to our caring and compassionate workforce. We are also directing funds into stronger mental health and well-being support for care staff, because colleagues cannot care for people unless we care for colleagues. We are putting funds behind a change in the services we provide to support unpaid carers, and we will find and test what works best for those who are caring under challenging circumstances. Regardless of whether that solution is old or new, if it works, we want to do it. We are also considering funding local areas to support their efforts to innovate around the care they provide, so that they can provide more options that suit people’s individual needs. Those new models of care, including housing with care, have the potential to play a pivotal role in delivering care that promotes prevention, is more personalised, and enables people to live independently.

Our third principle is care that is fair and accessible for everyone. We are introducing a cap on care costs so that no one will have to pay more than £86,000 over their lifetime. That cap will be there for everybody, regardless of any conditions they have, how old they are or how much they earn. It is a universal cap. Importantly, it will provide everyone with the peace of mind of knowing that the days of unlimited and unpredictable costs are coming to an end. The reforms will also make the existing means test far more generous, compared with both the current system and with previous abandoned proposals. Crucially, the £100,000 upper capital limit will be available to those in home care, and we expect many more people to be in home care. Let me be clear: no one will be worse off compared with the current system, and many, many people will be better off. All the ambitious plans that we are setting out today must be underpinned by a sustainable care market. The £3.6 billion we are giving to reform the social care charging system will help all local authorities to pay a fairer rate for care and put back into the system the fairness we all want.

Before I conclude, Mr Speaker, allow me to put on record once again my thanks to everybody who has played their part in developing this important White Paper. The reform of social care in this country has been ducked for far too long, but we will do whatever it takes to take on this tough challenge, and we will get it right. Today’s White Paper is an important step on our journey to giving more people the dignified care that we want for our loved ones, setting out important changes that will last for generations and stand the test of time. As a Government we are determined to get this right—I am determined to get this right—so that we can build the healthier, fairer and more caring country that we all deserve. I commend this Statement to the House.”

Photo of Baroness Wheeler Baroness Wheeler Shadow Spokesperson (Health and Social Care), Opposition Deputy Chief Whip (Lords) 2:42 pm, 2nd December 2021

I thank the Government for the Statement, which has been a long time coming.

First, we are told that we have a health and social care Bill to deal with integration across the NHS and social care. Instead, we get a giant Bill that is largely about NHS reorganisation to undo the structures set up by this Government in 2012. We are also told that there is a plan to fix social care, but we now have a government levy that has working-class families paying for extra funding that could in any event result in the NHS swallowing up most of the money to deal with the ever-growing waiting lists for vital treatment, with little left for social care. Finally, we have the grand announcement of the care cap, for which there was strong cross-party support when it was first proposed by Andrew Dilnot in 2011 and legislated for in 2014. However, it is now due to be delayed for yet another two years and introduced at half the level recommended by Dilnot, with the terrible and deadly sting in the tail of the last-minute amendment to the NHS Bill that was forced through the Commons last week and means that state-funded care costs will not be counted towards the care cap at all.

I remind the House that we have waited for this social care White Paper for four years, with unexplained delay after delay against a backdrop of expectation that, when it finally came, the NHS and care Bill would embrace NHS and social care integration. The proposals for this and other measures in the White Paper should have been an integral part of the Bill, which we will begin to debate next week. Can the Minister tell the House how the integrated care system under the Bill will be integrated for social care? Will there be another piece of legislation? If so, what will it seek to do?

Of course, Labour has called for and supports a number of the measures in the White Paper, such as improving the housing options available to older and disabled people and the potential for technology to improve standards of care. However, there are two central flaws in the Government’s latest approach. First, Ministers have utterly failed to deal with the immediate pressures facing social care as we head into one of the most difficult winters on record. Secondly, they have failed to set out the long-term vision and reforms that we need to deliver a care system fit for the future.

Last week, we learned that a staggering 400,000 older and disabled people are now on council waiting lists for care, with 40,000 of them waiting more than a year. There are more than 100,000 staff vacancies and turnover rates are soaring. Because of these shortages, 1.5 million hours of home care could not be delivered between August and October alone, and half of all councils report care homes going bust or home providers handing back contracts. Hundreds of thousands of older and disabled people are being left without the vital support they need, piling even more pressure on their families and the NHS at the worst possible time.

Does the Minister recognise the figure, reported this week, that 42,000 care staff have left their jobs since April? How will this White Paper ensure that care homes facing huge staff shortages can stay open and recruit and retain staff? Absolutely nothing new has been announced to deal with these crucial issues. Where is the plan to end waiting lists for care? Unless people get support when and where they need it, they will end up needing more expensive residential or hospital care, which is worse for them and for the taxpayer. We know that improving access is the first step in delivering a much more fundamental shift in the focus of support towards prevention and early intervention so that people can continue to live independently in their own homes for as long as possible. Without enough staff with the right training working in the right teams, this will never be achieved.

Where is the long-term strategy to transform the pay, training and terms and conditions of care workers, and to deliver at least 500,000 additional care workers by 2030, just to meet the growing demand? Why do the Government persist in having separate workforce strategies for the NHS and social care when the two are inextricably linked? Where is the joined-up strategy for the whole health and social care workforce?

The proposals in the White Paper for England’s 11 million family carers, who provide the vast majority of care in this country, are, quite frankly, pitiful. Unpaid carers have been pushed to the limit by trying to look after the people they love. Almost half said that they had not had a break for five years, even before the pandemic struck, and 80% of them are now providing more care than ever before. However, the funding announced amounts to just £1.60 more for each unpaid carer per year. Does the Minister not agree that families deserve so much better?

What was needed today was a long-term vision that finally puts social care where it belongs: on an equal footing with the NHS at the heart of a modernised welfare state. Can the Minister explain how this White Paper does that and delivers the resources needed to bring it about? At its best, social care is about far more than just helping people to get up, wash, dress and get fed, vital though this is. It is about ensuring that all older and disabled people can live the life they choose in the place they call home, with the people they love and doing the things that matter to them most. This should have been the guiding mission of the White Paper, with clear proposals to make users genuine partners in their care by transforming the use of direct payments and personal budgets, and ensuring that the views of users and families drive change in every part of the system, from how services are commissioned to how they are regulated and delivered.

The Government’s proposals fall woefully short of the mark and the reality of their so-called reforms is now clear: it is a tax hike on working people that will not deal with the problems in social care now. It will not even stop them having to sell their homes to pay for care, as the Prime Minister has repeatedly promised. The simple fact is that, under the Government’s proposals, if you own a home worth £1 million more than 90% of your assets will be protected, but if your home is worth £100,000 you could end up losing it all. Millions of working people are paying more tax, not to improve their family’s care or stop their own life savings being wiped out but to protect the homes of the wealthiest. This is not fixing the crisis in social care, let alone real social care reform. It is unfair and just wrong.

Photo of Baroness Brinton Baroness Brinton Liberal Democrat Lords Spokesperson (Health)

My Lords, I thank the Minister for the Statement. It is no exaggeration to say that we on these Benches, along with many other noble Lords, have been repeatedly pushing Ministers to publish this White Paper for years. It is now two and a half years since the Prime Minister announced from the steps of 10 Downing Street:

“My job is to protect you or your parents or grandparents from the fear of having to sell your home to pay for the costs of care. And so I am announcing now—on the steps of Downing Street—that we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve … that is the work that begins immediately behind that black door.”

We were pushing because it was evident even then that adult social care was already in crisis. High levels of staffing vacancies, and cuts to local government meant that fewer people who had been entitled to state support would receive it, as the criteria for eligibility were repeatedly tightened. Even then, it was common knowledge that private patients were having to subsidise those funded by the state, as the amount given to local authorities did not match the actual costs of that care.

Even allowing for the inevitable delays caused by the pandemic, this Government have insisted on continuing with their structural reforms, rushing through the Health and Care Bill—which NHS leaders are now asking to be delayed because of the continuation of coronavirus and its pressure on all NHS services—as well as the health and social care levy, rushed through your Lordships’ House in one day, six weeks ago, which now requires amendment in the Health and Care Bill, which will mean that house owners outside the greater south-east will end up paying a higher percentage of their assets than those in the greater south-east. So much for protecting them from the fear of having to sell your home to pay for the costs of care—yet another broken promise from this Prime Minister.

In setting the scene, we and others have pushed for the publication of the White Paper prior to the Bill starting its journey in the Lords, because we cannot understand how any Government could restructure integrated care services between the NHS and the care sector without knowing what plans they have for the future of the adult social care sector. Yesterday’s paper was deeply disappointing—but I think the Government know that, which is why Ministers announced yet another White Paper next year on integration. But hang on: was that not why this White Paper was due to be published? If there is to be another White Paper, the timing is important. Can the Minister say when this new White Paper will be published? This one certainly is not the answer.

Allocating some money to developing the workforce in five years’ time will not even start to address the current crisis in social care: with well over 100,000 vacancies; with social care providers still having to pay for expensive PPE that is provided free to the NHS; and with providers handing back state-funded payments to their local authorities because they cannot provide a safe service for those patients. It does not address the current practice, caused by lack of funding, of domiciliary care workers not being paid as they travel between clients. It does nothing to change the experience of unpaid carers. There are lots of great ideas about following best practice and getting people to talk together, but there is no real offer of funding for regular respite care or other benefits and support.

Reading the full White Paper, the truth about the promises in the Statement begin to be revealed. The Minister knows that, from these Benches, we have repeatedly emphasised the importance of housing in relation to care and support for adults of all ages. It was, therefore, perhaps encouraging to read the recurring phrase

“Making every decision about care a decision about housing”, but closer examination of the funding for disabled facilities grants increases shows that there will be £570 million a year in 2022–23, 2023-24 and 2024–25. The current budget for this year is already £537 million. Although continued funding is welcome news, this is only a £33 million—or 6%—increase, which, given rising costs of labour and materials, will barely keep up with inflation. It is not the transformative grant that the Statement trumpets. On the funding for

“a new service to make minor repairs and changes in peoples’ homes, to help people remain independent and safe”, for which most authorities are able to offer only £1,000 to £2,000 per person before they have to look at their assets, no cash amount is specified, but it is hoped that this will give a boost to handyperson services that are so highly valued by older people and provide such a great return on investment.

It is impossible to transform way our social care provision works, keeping people in their homes, unless this White Paper demonstrates the practical support that the Government can give to make that happen. The real difficulty we face is that staff in the sector, providers, the NHS and, above all, the users and their families are severely let down by the White Paper. The word “dignity” is used repeatedly in the Statement. The reality is the opposite: no vision, no real reform and, worst of all, no attempt to deal with the current crisis.

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

My Lords, I thank the noble Baronesses for the points they raise. But let us be clear that for many years—not just five, 10, 15 or 20 years; some noble Lords have said that we knew this issue was coming after the war, in the 1950s—the demographics of the country meant that we were going to have an ageing population, and successive Governments of all colours have not grasped the nettle. They have commissioned a report, it has gathered dust on the shelf and another report has come along. Many noble Lords, including my noble friend Lord Lilley and others, have written papers for various think tanks, but those also gathered dust and nothing has been done. When I have spoken to friends of all political colours, they have said that, frankly, it was too difficult and there were other priorities. So the Government should be given some credit for finally grasping the nettle.

We have set out a vision. Before you set out a strategy, you have to set out a vision, and we have done so. This is a 10-year vision, and we have committed to the first three years. Throughout the White Paper, we have said that we will continue to consult the sector—experts, carers, both paid and unpaid, local authorities and nursing or care home providers—to make sure that we get the right balance and understand the issues. As technology develops—medical technology, information technology and other technology that enables people to live in their own homes—we will see how the vision might adapt, rather than laying out everything from day one. We have laid out the vision and the spending for the first three years, but we will continue to consult to ensure that we are adapting to the changing technology and circumstances.

Compared to the current system, more people will be supported with their social care costs and have greater certainty over what they pay and receive higher-quality care. We think the plans announced represent the best value proposals. As many noble Lords will appreciate, that means balancing many issues: how many people are supported; how much they are supported; and the cost to taxpayers of offering that support. We believe that the plan sets out an appropriate level for the cap and balances that with people’s personal responsibility for planning for their later years. A number of experts have written recently asking why financial advisers advise people to build up ever-larger sums of money but they then leave it to their children at the end of their lives, rather than depleting their assets as they get older to look after themselves. We were clear that the £86,000 would be the amount individuals will need to pay towards the cost of their care, and the amendment to the Health and Social Care Bill reflects the changes. We believe the new system is necessary, fair and responsible.

We admit that the Care Act 2014 was landmark legislation informed by a range of partners, and we want to build on those strong foundations, rather than reinvent the wheel. Many of the provisions in that Bill act as a platform for better, even more joined-up health and social care in future. We are the first Government to announce that we are going to integrate health and social care, and that we will have a system of healthcare all the way through—not social care as a bolt-on afterwards—from your birth all the way through your life.

The Health and Social Care Bill contains several provisions built on the Care Act 2014. We have looked at assurance, with a new duty on the Care Quality Commission, and we have looked at data, to make sure we have the appropriate data on adult social care. People should pass from hospital to social care with no delay and as seamlessly as possible. We have looked at provider payments and the better care fund. The Bill also proposes to put integrated care systems on a statutory footing, which will make sure that, in each area, working with local authorities, account is taken of the needs of social care, joined up with the other parts of the healthcare system.

On 3 November, we published the adult social care winter plan, because we recognise that this is a long-term plan, but we have constantly been listening to stakeholders and have drawn up recommendations with a number of people, including Sir David Pearson, who reviewed last year’s adult social care plan, advisers from SAGE and UKHSA. So we have listened carefully to make sure that we meet some of the short-term issues that we are facing. We have looked at how we can increase spending, where relevant, to make sure that we tackle some of those issues.

Across the House, noble Lords will want to pay tribute to social care workers, both paid and unpaid. We have a track record of responding to workforce pressures—for example, the £162.5 million workforce recruitment and retention fund and the £388 infection control and testing fund. We will continue to keep this situation under control. We are also increasing the rate of the national living wage, which means that many of the lowest-paid care workers will benefit from pay rises. We are also investing at least £0.5 billion in the way we support the development and well-being of our social care workforce—an investment in knowledge, skills, health and well-being, and how we drive the retention of existing staff and boost recruitment. This will set the conditions for professionalisation over a longer period, giving carers recognition. When we look at the social care workforce and how much they are valued, one of the great issues has to be recognition of their skills and giving them a professional development pathway.

In the longer term, as set out in the White Paper, we remain interested in working with commissioners and providers to make that sure care workers have the best terms and conditions possible, including being paid for all the hours possible. This is already set out in our existing market-shaping and commissioning guidance. We will also explore how we can champion best practice and support local authorities, including through the new CQC assurance framework. We acknowledge the prevalence of zero-hours contracts in the social care sector and we are interested in working with commissioners, providers and care workers to understand how those contracts impact this sector.

Chapter 6 of the White Paper sets out three key aims for the workforce strategy over the next three years, backed up by £500 million of investment. We want to create a workforce that is well-trained and well-developed, healthy and supported, sustainable and recognised. We want to make sure that social care is seen as a rewarding career—that it is not only heart- warming but has professional recognition. I should stop there and take some more questions at this point.

Photo of Baroness Thomas of Winchester Baroness Thomas of Winchester Liberal Democrat 3:02 pm, 2nd December 2021

My Lords, could the Minister say exactly what the Government are doing right now to recruit more carers, in view of the huge shortfall in the workforce? Are they largely leaving it to hard-pressed local authorities?

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

The Government are in conversation with local authorities at the moment to look at the short-term issues. That is why we have announced increases in funding, particularly as part of the winter plan. The White Paper we are talking about today looks at the longer term, but we have also recognised the short-term issues, which is why we have announced these increases in spending.

Photo of Baroness Pitkeathley Baroness Pitkeathley Deputy Chairman of Committees, Deputy Speaker (Lords)

My Lords, we have been waiting for four years—sometimes I think I have been waiting 40 years—for a White Paper that contained a vision for social care that would, once and for all, rescue it from its Cinderella role in public services. I did not get that, but I am a glass-half-full person and am relieved by how many times unpaid carers are mentioned and how many warm words there are about identifying, recognising and involving carers. I thank the Government for that.

But family carers are at breaking point now. As my noble friend said, most have not had a single break since the start of the pandemic. They need immediate help, so will the Minister tell the House how the proposals in the White Paper will help stressed carers now? My second question is about integration between health and social care services, which is the only hope for real reform. It is frequently referred to in the White Paper, but there is no vision for how it will be delivered. We understand that another White Paper about integration is being prepared; I wonder why that is necessary when it could have been tackled in this one. Could the Minister update the House on progress and assure me that carers will be consulted as that paper on integration is written?

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

First, I pay tribute to the work that the noble Baroness has done for carers over many years. She has personally raised with me issues with carers, both paid and unpaid, as well. The White Paper clearly raises issues of professionalising, training and recognising carers to help make this a rewarding career for many. At the same time, it looks at unpaid carers and understands that, for a number of reasons, they are not all similar. Sometimes they are school-age children. We have looked at young carers and at elderly carers—for example my mother, who, in her 70s, looks after an 80 year-old sister who suffers from dementia. They have different needs.

We are first trying to look at how we can help make their task easier, for example through technology freeing up time. We are also looking at respite and how we can make sure they have breaks. We hope that those conversations will be had at the local level, between ICSs and health professionals having meetings directly with the individuals concerned to make sure that unpaid carers have the appropriate support.

Photo of Baroness Fox of Buckley Baroness Fox of Buckley Non-affiliated

My Lords, I feel torn on this. On the one hand, it is irritating that the White Paper has come out but everybody wants to bash it, when I am relieved that somebody has suggested something. On the other hand, it is not satisfactory. To ask some immediate questions, the crisis of care staff has already been referred to, but I am concerned that the White Paper is being used to avoid talking about the real crisis now. There are genuine problems in care homes in the aftermath of Covid. It is not just about staff, but the fact that relatives are still being denied face-to-face visits. There is still a climate of risk aversion and fear from some managements, with lots of people with dementia being locked in their rooms. All sorts of terrible things are happening and people do not know what to do. I do not want this White Paper to be used to bat things away.

That was the first thing. Secondly, in the longer term, can the White Paper create that vision and be used as a platform? To be honest, I think it is visionless and technocratic. We need to get talking and involve the nation in developing the vision we need. Everybody has an investment in improving this.

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

The noble Baroness, Lady Fox, makes a valid point: we have to look at not only the long-term vision but the short-term issues raised. This is why, on 3 November, we announced the adult social care winter plan for 2021-22. This was developed in conjunction with the NHS and social care stakeholders. We drew on the recommendations of the review of last year’s adult social care winter plan and listened to a number of different stakeholders in setting out the short-term issues.

As the noble Baroness acknowledges, we are the first Government to set out a long-term vision, not just from one electoral cycle to another but for 10 years. We have set out a vision with three years of commitment to specific spending, some of which is a discovery process, because we still have to know what will and will not work, and how to use and integrate technology. By doing that, we have laid down the gauntlet to whatever Government come after us, of whatever political colour, for them to continue to fulfil this vision. It is a vision against which this and future Governments will be measured.

Other politicians from other parties have known about this for many years. The noble Baroness, Lady Pitkeathley, mentioned waiting for 40 years and others have known about our post-war demographic challenge. We have finally grasped the nettle. We are not going to get everything right, which is why we have not laid out a detailed, prescriptive plan for 10 years. We have laid out a vision of integration, making sure that we use the best technology to support people in their own homes, as much as possible. At the same time, we have committed for the next three years. After that, the challenge is for us to work with all stakeholders to deliver that vision.

Photo of Baroness Watkins of Tavistock Baroness Watkins of Tavistock Deputy Chairman of Committees

My Lords, I am particularly delighted to see this White Paper and congratulate the Government on publishing it in this timeframe. However, we need to look closely at workforce needs, at the same time as we look at workforce needs for the Health and Care Bill, because there is a real mismatch between the vision we now have and the staffing for that vision. I welcome this opportunity to hear how the Government think we can tackle that and give young unemployed people good opportunities to come into a proper caring profession.

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

I thank the noble Baroness for the conversations that we have had about this, and a number of other issues, as I got to grips with my brief. She makes a very important point. We have to make sure that social care is seen as an attractive career path and not just something unskilled; we know that there are skills involved, such as empathy. There will also be an increased need for digital skills, and people management skills will be handy in other areas. For far too long, social care has been seen as the poor relation of other parts of the health system. By bringing health and social care together, we are sending a signal that our vision is to put them on an equal footing. We are also explaining how we intend to spend over the next three years. We challenge everyone—stakeholders, local authorities, everyone—to come forward and help us develop that vision for the long term, and to hold future Governments to account against that vision.

Photo of Baroness Walmsley Baroness Walmsley Co-Deputy Leader of the Liberal Democrat Peers

I wish the Minister good luck with his nettle grasping—I think he is going to need it. He will know that the right housing is key to enabling people to remain safely and happily in their home, yet only £300 million, a very small amount, is being promised in the White Paper to integrate housing into health and care strategies. Take, as an example, the so-called extra care units, where people can live in a flat with appropriate on-site support; that will mean only about 3,000 such units across England. Can the Minister say over what period that money is being offered? Is it three years or a different period? How many units of supported housing can be provided for that amount of money?

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

I thank the noble Baroness for raising this issue. We want to ensure that people can live in their own home for longer. We have committed a sum of money and been quite clear that practical changes can be made, such as installing stairlifts, level-access showers, wet rooms, sensors, et cetera. New technology is constantly being developed to meet people’s needs in their own home. To this end, we have committed a further £573 million per year to the disabled facilities grant, from 2022-23 to 2024-25. We are also talking to local authorities and others, looking at whether we need to increase the subsidy amount per adaptation and reconsider funding allocation to better align with local needs, as well as funding a new service to enable minor repairs and changes to people’s homes. We need to know what needs to be done, and local authorities and others can come back to us on the adaptations that they need and the best way to achieve them. We must look at best practice to make sure that, as technology develops, people can stay in their own home for longer.

Photo of Lord Dubs Lord Dubs Labour

My Lords, I declare an interest; my daughter-in-law is a full-time unpaid carer. First, the report says that unpaid carers’ money will go up to £69.70 a week. That is fine if you also have a job, but quite a few unpaid carers have given up their jobs to be unpaid carers, so that is all that they have got, other than the benefit that the person they are caring for may get. That is a pretty tough situation. Secondly, unpaid carers get very few breaks—some get no breaks at all. We must devise a way of looking after the 10 million or 11 million people who keep everything going. Although there are aspirations in this document, I would like to see them translated into something absolutely practical, so that I can go to an unpaid carer and say, “You’re full time, and something will happen to help you and take off the pressure.” It is a lonely business working full time, on virtually no money, looking after somebody. If the paid carers who come in the mornings or evenings do not turn up, it is the unpaid carers who keep things going. I hope that the Minister will pay attention to that. There is a whole agenda there which many of us will be pushing very hard on.

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

I know that the noble Lord has been a champion in this area. We have been quite clear that, as we go forward, a number of issues have to be understood. For example, you cannot say that all unpaid carers are the same. They all have different needs: some can work and some cannot work; some can spend a couple of hours working and share their care duties with others; there are sole carers; some are elderly and some are younger. We want all the different partners to come together to discuss individual needs—including respite for carers, to rest and recharge—and to look at their financial situations. We have laid out that those who are not working may be eligible for other benefits on top of the care allowance that they get. We are exploring this. It is a process of discovery and we want to ensure that it works. We have therefore set out the vision and the three-year commitment.

Photo of Baroness Tyler of Enfield Baroness Tyler of Enfield Liberal Democrat

My Lords, I would like to pursue the points that were raised a minute ago by the noble Baronesses, Lady Fox and Lady Watkins. Despite the welcome long-term aspirations in the White Paper, the reality is that the chronic workforce shortages in social care are getting worse, with uncompetitive pay being the main culprit. If Covid surges this winter because of the new variant, these workforce problems will be magnified, with potentially disastrous consequences. There are similar concerns with unpaid carers, as the noble Lord, Lord Dubs, has just said. With no new resources from the new levy coming on stream until October 2023, and all the fragilities that I have just described, what are the Government going to do to address the pay and retention issues now, over this winter?

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

The Government have been listening to the workforce and understand its pressures. We recognise that this is the vision, and that we need to look also at the short-term issues. We announced £162.5 million for the workforce recruitment retention fund, and the new Made with Care scheme to recruit social workers and to send a message that social work can be a rewarding career. We are talking to different bodies, including the Department for Education, about how we increase professionalisation. We have also increased the national living wage, meaning that many of the lowest-paid workers will be paid more. We are investing at least half a billion pounds in supporting the development and well-being of the social care workforce, including an investment in knowledge, skills, and well-being. We will work with partners to set the conditions for the professionalisation over a longer period. We cannot do this immediately; we want to consult the education sector and care and social care experts, to give recognition. That will be a precursor to making progress on pay.

Photo of Lord Lilley Lord Lilley Conservative

Does my noble friend agree that the primary obligation of a Government is to provide decent care for those who cannot finance their own care, and that the lowest priority is to provide taxpayers’ funds to enable those who own valuable assets to pass them on to their offspring? If it is possible to enable people to insure against the risk of having to use the value of their home to pay for their own social care, possibly through a state-aided scheme, would that not be desirable? Is he not astonished that the Labour Party, normally the champion of public sector provision and the enemy of channelling public money to the rich, should advocate channelling money to the rich and not a state-funded insurance scheme?

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

I thank my noble friend for his question and pay tribute to him as one of the authors of a paper on funding social care, which had a number of interesting ideas. I am also very grateful to noble Lords across the House who have approached me with different ideas, including from the Labour Benches, these Benches and the Cross Benches. The Government have looked at a number of plans and have decided on this, but we are in conversation with the private insurance industry, including the ABI and others, to discuss what financial products it can offer in response to the changes. Some people are quite happy to take out insurance policies, but it depends on individual wealth levels and circumstances, and a number of different matters. We hope that there will be a development of the private market, and we are in conversations with the insurance industry. It has told this and successive Governments that, at the moment, there is no private sector solution for social care insurance. I regret that and wish that there was. My noble friend’s idea of the state underwriting it is interesting, but many reports have been written. I know that the noble Baroness, Lady Walmsley, will writhe in pain at this, but we have drafted that letter. Whatever we do, we will be criticised for it, but we will do this. We have set the vision for the first three years and have set the challenge for all of us to come together to provide the best possible social care for the future.

Photo of Lord Desai Lord Desai Non-affiliated

My Lords, I want to reinforce something that the noble Lord, Lord Dubs, said: the distinction between unpaid and paid care workers is very unfair because people who have to care do not have a choice whether to do so—they just do not get paid. The noble Lord mentioned his mother looking after her sister—there is no choice in that matter. Something ought to be done to redefine the category of unpaid social worker, perhaps by making such people part of universal credit so that they will get a statutory payment as of right—because they are relieving the state of some expenditure on care and, of course, performing a very useful social function.

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

The noble Lord makes the very important point that unpaid carers save the state billions of pounds a year with all the work that they do and the love and attention that they give. Sometimes, they do have a choice, but they choose to be carers because they are worried about putting their relative into a home and are not quite sure about that—I understand that. But the fact is that, if they are unpaid, we are looking at how we can support them better. Unpaid carers are very different, and you cannot lump them all into one group: they have different needs and are at different stages of their lives. I emphasise the importance of making sure that we understand how we can personalise that journey for everyone—the cared- for person and the carer. But, if you have given up work, a range of other benefits may be available, and we want to make sure that unpaid carers are equally valued and not penalised for looking after a loved one.

Photo of Lord Hamilton of Epsom Lord Hamilton of Epsom Conservative

My Lords, following on from my noble friend Lord Lilley’s remark, what percentage of people in need of care will be covered by the £86,000 cap?

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

I am afraid that I do not have the details of that, but I will write to my noble friend.