Private Members' Business – in the Northern Ireland Assembly at 12:15 pm on 8 October 2024.
I beg to move
That this Assembly expresses its frustration at the lack of progress on transforming the social care system since the 'Power to People' report was published in 2017; notes that workforce shortages, care home capacity constraints and long delays to access community care packages are leaving too many people without the high-quality services they need, when they need them; welcomes the contribution of front-line staff, providers and community and voluntary sector bodies in the work of the social care collaborative forum; and calls on the Minister of Health to bring forward the key policy development priorities from that collaborative forum without delay, including the health and social care workforce strategy 2026, revised care standards for nursing homes, review of the carers’ strategy 2006 and residential care home minimum standards.
The Business Committee has agreed to allow up to one hour and 30 minutes for the debate. The proposer of the motion will have 10 minutes to propose and 10 minutes to make a winding-up speech. As an amendment has been selected and is published on the Marshalled List, the Business Committee has agreed that 15 minutes will be added to the total time for the debate.
Adult social care is a perfect example of how to relieve pressure on hospitals and secondary care. Investing in domiciliary and community care is an early intervention and prevention mechanism that reduces the need for people to go to A&E, use the Ambulance Service or stay in hospital beds that they no longer need. However, social care is about more than just easing pressure elsewhere in the healthcare system. Most importantly, it is a vital sector that, I am sure, everyone will have interactions with at some point in their life, either for themselves or a loved one. Such services give people independence and ensure that they can live their life where they want and on their own terms surrounded by loved ones in the place that they can call home. It is crucial that social care is properly supported and that the workforce is valued for the care that it provides.
Unfortunately, however, adult social care is a perfect example of how slow we can be in Northern Ireland to make progress — something that I have been highlighting as an issue impacting on a range of areas across Health. I understand that the 'Power to People' report in 2017 led to the Department consulting on reform of adult social care in Northern Ireland, which then led to the creation of the social care collaborative forum to implement the outcome of the consultation through a number of separate work streams. The Minister has since confirmed to me and many others through answers to questions for written answer that any specific changes recommended by the collaborative forum shall be subject to public consultation.
I want to focus on that for a moment. As many others do, I acknowledge the fact that consultation is important, as is co-production, but the Department of Health will be consulting on an issue that it has already consulted on again and again. Do not get me wrong: that collaboration is key, and we need to hear again from people in the sector, but I fear that we will now use this as a mechanism of delay rather than one of positive action. We are stuck in a labyrinth of bureaucracy, where change will be a never-ending discussion, while services on the ground continue to deteriorate in the face of growing demand and an ageing and sicker population. That has all been exacerbated by COVID and the instability in this place.
In recent months, many questions for written answer to the Minister about social care have been answered with reference to the ongoing work of the collaborative forum, which is due to continue into next year. My frustration is not with the people and organisations involved — they are doing valuable work — but with the fact that so little progress has been made on the recommendations from the consultation. It is disappointing that I am able to say the same thing that I said in today's earlier debate about children's social care services, and we have heard that from stakeholders involved in children's social care and adult social care.
I appreciate, though, that there are annual updates on the work of the collaborative forum through the end-of-year reports and delivery plans. However, the reality is that many queries and issues raised around social care reform receive the stock answer of, "The forum is looking at this". These key questions remain: when we will reach the point of action? When will service users benefit from outcomes on the ground? I am sure that the Minister will not be surprised to hear me say that, while, of course, I understand the difficult financial constraints that he and every Executive Minister currently face, I am keen to focus on how the current available budget can be used in a more strategic way by, in this case, looking at investing in measures that will have more impact in the long term: workforce, domiciliary care and early discharge, among others.
I am also keen to highlight that there are policy changes that can be made at little to no cost that would begin to have an impact on the ground in the social care sector. The issue of third-party contributions from family members of those in care homes has been raised by a number of constituents right across Northern Ireland, and I was shocked to discover that the Department's guidance dictating the charging of third-party contributions has not been updated since 2010. In addition, when I submitted questions to the Minister to dig deeper into the criteria of that guidance, I was told that the proximity to the individual's family, loved ones and support system is not taken into account when deciding which care home accommodation is appropriate. How can a care home be classed as appropriate if family members and loved ones live unreasonable distances away when the individual can no longer rely on their support system in times of need or has to pay extra money to stay close to that support system?
The Assembly has debated the issue of tackling loneliness countless times, yet we are embedding the threat of loneliness in this way by placing people in care homes that are far too far away from their loved ones.
I thank the Member for giving way. Does she agree that the implementation of top-ups not only makes it even more difficult for families who are not in a position to pay those fees but restricts the choice for many people who do not have that family support or whose family simply cannot afford it?
Absolutely, I agree. I am sure that the Member has been in touch with constituents who have had responses such as, "Oh, you do have options". However, in reality, because of the cost, they do not have those options.
We must get the guidance updated to include proximity. That would not require upfront investment — we look forward to hearing whether that is the case — but would have a massive impact on ensuring that individuals feel more secure in the care home accommodation that is provided while reducing the burden of third-party contributions on families. It is for that reason that we welcome the DUP's amendment. The current charging arrangements are highly unfair and inconsistent. I look forward to seeing urgent progress on the review of those.
I note that the social care collaborative forum has committed to reviewing, updating and issuing revised nursing home and residential care home minimum standards by March next year. I am keen to receive from the Minister an update on that work and a commitment that those new minimum standards are on track to be issued, with care homes notified of the updates by the end of the financial year, in line with the commitment in the delivery plan. As I have said before, this is a plan, but we do not need more plans. We need action. We need to see change.
We all know, as it has been debated in the Chamber before, that there is no service without a sustainable workforce that has clear opportunities for career progression and fair pay and working conditions. Indeed, that was made clear in the review of adult social care and the consultations that followed it. While they highlight the crucial role that improved pay and conditions will play in improving recruitment, capacity and quality of service, there are other recommendations on improving the workforce that may not need major funding in order to be progressed, such as improving the requirements for the induction, support, development and supervision of the workforce, values-based recruitment and, crucially, ensuring that the workforce feels valued. Has the collaborative forum made any progress on improving staff inductions and the opportunities for staff development, and will that be implemented? I note that the forum also committed to publishing the finalised social care workforce strategy by December this year. Can the Minister give some comfort today to those workers in the social care sector, who far too often do not receive the recognition that they deserve, by confirming that that will be the case?
Another recommendation that the report states is crucial to all aspects of the reform and that will improve consistency and standardisation of services is a regional approach to data collection for all social care services. That will ensure consistency right across the sector. I know that there is a dedicated work stream in the collaborative forum for supporting unpaid carers. The most recent delivery plan commits to recommendations on the development of an expanded carers' register by September this year. However, we are already in October, so where are we with those recommendations? There was also a commitment to a complete review of the 2006 carers' strategy? Where are we with that? I commend the work of those in the sector who participate in the work streams, because they are dedicating their time and resources and are acting in good faith, hoping to see tangible outcomes for the sector and for people on the ground.
Carers NI published its policy document, 'A New Deal for unpaid carers in Northern Ireland', over a year ago. It contains a number of recommendations. I look forward to hearing the Minister's response.
Another aspect that I would like to touch on is the adult safeguarding Bill. We, as members of the Health Committee, are well aware that that is in transit through the Health Department, but we would welcome it coming to the Assembly in as reasonably timely a fashion as possible. That is because it is crucial that everyone has confidence and faith in the social care system.
I recognise that some of the work that I mentioned is cross-departmental. It is a massive task, and I do not underestimate that. However, the first consultation on adult social care reform was in 2012. It is now 12 years later. We need to see action and progress and to ensure that adults in the social care system, and the families who support them, get the right help.
I beg to move the following amendment
Insert after "when they need them;": "is concerned that current charging arrangements for adult social care in Northern Ireland are unfair and inconsistent; believes the Department of Health should explore the potential benefits of independent price regulation within the care sector;"
Diane, you will have 10 minutes to propose the amendment and five minutes in which to make a winding-up speech. All others Members will have five minutes. Diane, please open the debate on the amendment.
Thank you, Principal Deputy Speaker. I propose the amendment not to take anything away from the motion but merely to add to it an issue that has come to my constituency office and that Members may have experienced in their personal lives. I thank the proposer of the motion for supporting the amendment, because it is important.
I want to highlight a number of things, but, mainly, I want to focus on delayed discharges from hospitals. The amendment addresses the need to ensure that we have appropriate costs for care and VAT in care homes. Nothing highlights the link between health and social care better than the difficulties with delayed discharges from our hospitals: the obscenity of hundreds of beds being out of use for operations in acute care because people who are medically fit remain in hospital awaiting care packages.
Back in the spring, the Minister provided me with figures demonstrating that, on 15 March, 628 patients across Northern Ireland had a needless stay in hospital. The real figure might have been higher, as some trusts had only included in the calculation the beds on their largest acute sites, and that was well into the spring, when the annual winter surge of respiratory cases may well have subsided. Having more than 600 hospital beds unavailable is the equivalent of keeping the doors locked at one of our large acute hospitals and at another small one. It is the equivalent of locking the doors at the Royal Victoria Hospital and saying, "We can do no more admissions today." It is an issue that really must be tackled.
Hospital staff are forced to go to work each morning with one arm tied behind their back. It ought to be a key objective to free up more capacity and allow the system to operate. The loss of beds impacts on all parts of the system, including waiting times, emergency departments and hospital admissions. It is poor care, too, for those patients who are kept in hospital unnecessarily. Many argue that we do not have enough hospital beds in Northern Ireland in the first place, but we certainly cannot afford to lose 600 beds within the system at any one time. I recognise that there can be difficulties finding replacements for individuals, but the issue needs to be gripped from the centre. It is a straightforward opportunity to transform hospital provision. For anyone looking in from the outside, or from any other walk of life, it is a simple means of making a fundamental impact on the efficiency of the overall system.
The second issue that I want to highlight is regulation in the care sector. Too often, we hear that social care is not sufficiently valued. It is not helped by how it is funded. Down the years, providers of social care have had little confidence and, at times, uncertainty around that funding. The impression has always been that, when the financial envelope is squeezed, social care is one of the very last areas of the budget that will be considered. Whatever is left at the end of the budget process is what will be available to social care. Rather than being able to plan medium- and long-term care homes in domiciliary care, for example, the sector has had to put up with whatever the Department and the trust gives it. None of that assists in making the care sector an attractive one in which to work or seek to build a career. If the Government and the powers that be do not value social care, why should anyone else?
The idea of regulating care costs was raised as far back as the Transforming Your Care review led by John Compton. That was when Edwin Poots was the Health Minister, so it is a long time ago. On social care, 'Transforming Your Care' stated:
"the Review ... recognises that the relationship with government, particularly over pricing can be difficult. Consequently, the Review recommends the" —
Department —
"undertakes a policy review to consider: • the benefits or otherwise of independent price regulation within the sector".
Proposal 20 of the review specifically recommended:
"An overhauled financial model for procuring independent and statutory care, including exploring the potential for a price regulator".
I mention that aspect and included it in the amendment because I know, as the Chair of the Committee said in her intervention, that many of us will have heard from families who are desperate because of the top-ups that are required from part of the independent sector. It is not a choice for families. Often, families just do not have the means to make those top-ups, and we really need to have some means of regulating them, particularly when they can reach extreme amounts very quickly. That is why we tabled the amendment.
Financial stability in the sector would be of immense benefit and would place a value on caring and the other work that those in the social care sector do. There also needs to be action to strengthen our domiciliary and social care workforce, such as making it more attractive by improving working conditions, establishing career pathways and providing support for staff. Mandatory training and professional development should be introduced with pay progression linked to skills, experience and qualifications.
Finally, is the Minister able to provide an update on VAT for care home operators? I tabled a number of questions for written answer, to which I received responses in June, on Northern Ireland care home operators not being able to reclaim VAT to the same extent as their counterparts in other parts of the United Kingdom. Health and social care trusts are permitted to reclaim VAT on non-business activities, under the provisions of the Value Added Tax Act 1994. The regional residential and nursing home specification and contract, however, which was issued to trusts in 2015, does not permit independent homes to do so. The Minister answered:
"Independent Sector registered care homes in Northern Ireland are VAT exempt but related expenditure is not recoverable."
A further answer stated:
"Workstream 8 of the Social Care Collaborative Forum has been established to ... review ... the current Regional Residential and Nursing Home Specification and Contract."
The Minister advised me in June that the VAT issue was being prioritised for early consideration by the commissioning and contracting work stream. Can the Minister provide the Assembly with an update on that and on whether the issues have been resolved? In mentioning that, it is clear to me that, if there is additional money that can stabilise it, we should help the care home sector avail itself of that additional money, because we would like to see it being ploughed back into additional provision and care for those who require it.
I am glad that the proposer of the motion is agreeable to our amendment, and I commend it to the House.
I thank the Alliance Party for tabling the motion and the DUP for tabling the amendment, and we will support both. It is clear that the issue is critical to ensuring that our health and social care systems continue to function efficiently and effectively and deliver a much higher quality of life and better outcomes to people requiring care and to their families and carers. As with the subject of the previous debate, it is clear that the adult social care system requires significant transformation in order to deliver properly for some of the most vulnerable people in our communities. Having a fully functioning social care system will also ensure that our hospitals can sustain an efficient patient flow from the front door to the back door, as the Member who spoke previously outlined.
Just last Thursday, I, along with some other members of the Health Committee, visited the Ambulance Service dispatch headquarters, where we heard directly from the people in the control centre taking ambulance 999 calls and calls from paramedics working on the ground. We heard clearly about the precarious situation that the Ambulance Service often finds itself in and about the difficult calls that those staff have to take, which involve keeping people on the line for significant periods while they await an ambulance to attend to them. That is coupled with the prolonged waits outside our emergency departments, and it is shocking that those waits are often for longer than 24 hours, with patients seeing numerous shift changes as they stay in the ambulance until they can be transferred into the hospital. That is often due to the unavailability of beds, which is causing bottlenecks in our EDs. That can largely be attributed to the inability to source care packages and care home placements to discharge medically fit patients from hospital.
While the motion focuses on the need to make urgent progress on the work of the Social Care Collaborative Forum, it is important that we emphasise that not only is this impacting on individuals requiring care and their families and carers but the knock-on impact on others in need of urgent and unscheduled care is huge, as well as the additional pressure and distress for many staff — in hospitals and in the Ambulance Service — who often feel powerless as they wait to get patients into the hospital, often for a long time.
The failure of our system to deliver accessible, reliable and quality care for individuals and to support their carers and families cannot be allowed to continue. We need to see the changes that are needed implemented at pace to avoid the further deepening of the crisis unfolding before us. As someone who has worked in adult social care, I have never seen the scale of the challenges that we see now, with families waiting months to secure what would previously have been seen as a basic care package. That is simply not acceptable, and we should not normalise it, particularly as the onus then falls on unpaid carers, who are already giving everything to deliver care for their loved ones.
A number of things need to be addressed if we are to see the reform that is needed, but critical to this, first and foremost, is the workforce. I welcome the ongoing work of the Social Care Collaborative Forum in conjunction with other stakeholders — for example, the Northern Ireland Social Care Council and others — to make the caring profession more attractive but also to place appropriate value on carers as key people in our social care system, which will also allow for career progression and the development of skills. I look forward to hearing further information on the progress of workforce planning from the Minister.
I appreciate the huge challenges before the Minister and his Department. I do not think anyone here underestimates that, but, if we are serious about transforming our health service, a fit-for-purpose, high-quality social care system is key.
Today's motion addresses an urgent matter that affects the lives of countless individuals and families across the North: the transformation of our social care system. The topic has been discussed extensively, yet we find ourselves expressing frustration at the lack of meaningful progress since the publication of the 'Power to People' report in 2017. That report was meant to be a catalyst for change and a beacon of hope for those on social care services, but, nearly six years later, we still await the actions that are so desperately needed. The reality is stark: workforce shortages, care home capacity constraints and the long delays in accessing community care packages leave too many people without the high-quality services they require when they need them most. That is unacceptable. Our social care system is meant to provide support, dignity and care to those who are the most vulnerable, yet it is falling short. We must ask ourselves how many more families must struggle before we take decisive action.
I recognise the incredible contribution of our front-line staff, providers and community and voluntary sector bodies. Those individuals and organisations work tirelessly, often in challenging circumstances, to deliver care and support to those in need. They are the backbone of our social care system. However, admirable as their efforts are, we must acknowledge that they cannot compensate for a system that is in crisis. That is why the work of the Social Care Collaborative Forum is so vital. The forum has brought together key stakeholders to identify the challenges we face and to develop solutions that can lead us towards a better social care system. We are grateful for their contributions and insights, but we cannot afford to let the work sit on a shelf.
We need action, and we need to see it now. To that end, I call on the Minister of Health to bring forward the key policy development priorities from the collaborative forum without delay. That includes the Health and Social Care workforce strategy 2026, which is essential for addressing the workforce shortages that are crippling our services. As with all sections of our health service, we cannot provide quality care without a well-supported and adequately staffed workforce. It is time to prioritise the recruitment, retention and training of our social care professionals.
While the Department tells us that the vacancy rate in social work is 5·4%, the British Association of Social Workers has been informed of vacancy rates of 30% to 35% in family intervention teams and in excess of 40% in looked-after children's services. If we want to go into specifics, the Department needs to accept the reality that, if the adult protection Bill is to go ahead in this mandate, alongside the roll-out of multidisciplinary teams (MDTs), the Adoption and Children Act 2022 and the much-needed learning disability framework, we will need hundreds of new social workers. I ask the Minister this: where will they come from? How will we keep them? The entire system will need money.
I sound like a broken record, but, again, it is not lost on me that we have an Executive party motion and an Executive party amendment that ask a Minister from another Executive party to do something. It sometimes feels as though the conversations just go around in circles with people talking to themselves. You are the Executive, so, if you want to prioritise it, prioritise it, and let us stop talking about it.
We must revise care standards for nursing homes. Our elderly and vulnerable populations deserve to live in environments that meet their needs and ensure their dignity. Caring standards must reflect the realities of modern care and the expectations of the families who entrust their loved ones to those facilities. Furthermore, a review of the carers' strategy from 2006 is long overdue. Our carers are the unsung heroes of our social care system, often providing essential support without the recognition or resources that they deserve. We must ensure that they have access to the support, training and respite that they need to continue their vital work.
The time for talk is over. The people of the North are counting on us to act.
The Business Committee has arranged to meet at 1.00 pm today. I propose, therefore, by leave of the Assembly, to suspend the sitting until 2.00 pm. The debate will continue after Question Time, when the first Member to be called will be Diana Armstrong.
The debate stood suspended.
The sitting was suspended at 12.57 pm.
On resuming (Mr Speaker in the Chair) —