Covid-19: Social Care — [Derek Twigg in the Chair]

Backbench Business – in Westminster Hall at 2:39 pm on 22nd April 2021.

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[Derek Twigg in the Chair]

Photo of Derek Twigg Derek Twigg Labour, Halton 3:15 pm, 22nd April 2021

I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. Timings of debates have been amended to allow technical arrangements to be made for the next debate. There are also suspensions between each debate.

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Photo of Helen Hayes Helen Hayes Labour, Dulwich and West Norwood 3:16 pm, 22nd April 2021

I beg to move,

That this House
has considered social care and the covid-19 outbreak.

It is a pleasure to serve under your chairmanship, Mr Twigg, and to speak in this debate in person—for me, for the first time in the Boothroyd Room. I am grateful to the Backbench Business Committee for allocating time for this debate, and to my co-chair of the all-party parliamentary group on adult social care, Damian Green, for co-sponsoring it.

The APPG on adult social care has a working group of representatives from the social care sector, including not-for-profit care home providers, sector-wide bodies such as the National Care Forum and Skills for Care, and people with lived experience of managing their own care at home. From the start of the covid-19 pandemic, the working group met weekly to discuss the experience on the ground of each of the membership organisations and the individuals represented on it. I am also grateful to the shadow Minister, my hon. Friend Liz Kendall, and to the Minister herself for meeting the working group during that time.

Week by week, those meetings gave a vital live insight into the multiple devastating impacts of the covid-19 pandemic on the care sector. They often provided a reality check against what the Government were announcing. The right hon. Member for Ashford and I felt strongly that it was important to bring the weight of this collective experience before the House so that it may inform urgent discussions about the future of social care.

At the outset, it is important to acknowledge the diversity of the social care sector, as there is always a tendency to focus mainly on care homes for older adults when we talk about social care. It also encompasses care homes for working-age adults and people who receive all types of care in their own homes and in supported housing.

The covid-19 pandemic took a dreadful toll across the whole sector. Perhaps the most shocking figure, well reported, is that between March and June 2020, 40% of all deaths from covid-19 were care home residents. The deaths have continued, with a further 12,000 deaths of care home residents since January 2021 alone. More than 34,000 people with dementia have died from covid-19, and tens of thousands more have seen their condition deteriorate at an increased pace due to limited support and contact with loved ones. Those figures mask a human story: the tens of thousands of families grieving the loss of a precious loved one, remembering the full richness of the lives they lived, and the thousands more families grieving the loss of precious time that they cannot get back with loved ones whose dementia has deteriorated.

At least 850 social care workers have died due to covid-19. That figure is likely to be higher given the lack of availability of testing to confirm diagnosis in the early weeks of the pandemic. The vast majority of the care workers are women, many are black, Asian and from other ethnic minorities, and many had dedicated their lives to looking after other people. Each one leaves a grieving family, and we must acknowledge their service and sacrifice.

The figures also belie the diversity of the social care sector, because they do not include the impact on people receiving care in their homes, who were often vulnerable to coronavirus infection from carers visiting multiple homes. Sometimes, they felt unable to receive care at all, due to the risk of infection, resulting in untold hardship and difficulty. The figures also do not include the impact on unpaid carers, often left isolated and unsupported, or the impact on people living in unregulated supported housing.

Each week, the APPG working group heard of the problems accessing personal protective equipment and covid-19 testing. Providers were operating in the dark, with their hands tied behind their back, unable to know who was carrying covid-19 in their care homes and without access to full infection control measures.

Covid-19 ripped through many care homes, as the access to testing and urgent need to free up hospital beds for covid patients meant that undiagnosed covid-positive patients continued to be discharged from hospitals into care homes. The completely unacceptable blanket use of “do not resuscitate” orders for care home residents further speaks to the disregard for the most vulnerable members of our communities at the start of the pandemic.

I pay tribute to social care workers who stepped up to do extraordinary things in these horrendous circumstances —staff who moved into care homes, leaving their families in order to avoid the risk that they were a source of infection; staff who, again and again, held the hands of the residents in their care as they lay dying, when their loved ones were unable to be there; and staff who went out of their way to facilitate FaceTime calls to maintain contact with relatives who could not visit. Social care staff must be recognised for their immense contribution during the pandemic.

I will dwell for a moment on the mental health impacts of the pandemic, in the light of the situation that I have described. It is easy to forget that care homes are communities. Staff look after the same residents week after week, and relationships become like family. Many staff who watched residents and colleagues dying from coronavirus have experienced the trauma of bereavement many times over during the past year. I recall listening to one social care worker describing the first time in many weeks that residents with dementia in her home were able to come together for a music therapy session. One resident, looking around the room, said, “Where is everyone?” not understanding that so many residents had passed away. It is heartbreaking.

Contrary to the words of the Prime Minister and the Secretary of State for Health and Social Care, there was no protective ring around care homes or other vulnerable residents receiving social care at the start of the pandemic. The need for urgent reform of social care has been known for a long time. We have had more than a decade of detailed cross-party work on social care. The funding gaps are quantified. The international best practice is well understood. The range of options available for reform are known. What has been lacking is the political will at the very top of Government to deliver it.

Despite the Prime Minister promising in July 2019 that a plan was ready and that he would begin cross-party talks, there has been no progress nearly two years on. The Government have published the NHS White Paper, which barely mentions social care. We are told that there will be a 10-year plan for social care, but for all those working in social care, and relying on social care day by day, reform is long overdue. They are struggling to understand why the Government have dragged their feet so much for so long, for a sector that has such a profound impact on quality of life for so many people every single day.

From the perspective of the APPG working group, what are the priorities for the Government as we reflect on the impact of the covid-19 pandemic on social care? First, the promised public inquiry on the covid-19 pandemic must include a separate strand on social care, so that the lessons can be learned for future pandemic planning and social care can be better protected the next time we face such a terrible challenge.

Secondly, the Government must start the long-promised cross-party talks. Social care needs long-term reform, based on cross-party agreement. That will not be achieved by the Government announcing plans at short notice and simply expecting everyone to vote for them. It needs a process, properly resourced and entered into in good faith, to secure that agreement.

Thirdly, it is vital that co-production is at the heart of social care reform. Social care reform must be delivered in partnership with those who live and breathe social care every single day as residents in care homes, people who manage their own care at home, older people and working-age adults, social care workers, unpaid carers and local authorities. The Government must set out a process for co-producing reform with those who have the most knowledge and experience to contribute.

Fourthly, reform must address pay and terms and conditions for social care workers. Social care work is highly skilled and demanding and can be very rewarding, but there is not a route to social care reform that avoids the issue of pay. As well as making a huge difference to the lives of millions of people every day, social care contributes £46.2 billion to the UK economy each year. However, in many parts of the country it is still possible to earn more at the local supermarket than in social care. That cannot continue.

I pay tribute to Unison for its work in establishing the ethical care charter, which guarantees domiciliary care workers the real living wage, and an end to zero-hours contracts and 15-minute visits. It has been adopted by many councils, including Southwark, which covers part of my constituency. It not only benefits care workers, but helps build resilience in the social care system. This should not be left to the discretion of individual councils. There is a chronic shortage of social care workers, and the trauma that many have experienced during the pandemic is likely to make the situation worse. Social care must be seen as a rewarding career in which everyone is paid a decent wage. There has been no commitment from the Government to increase pay for social care workers, and I call on the Minister to change that urgently.

On long-term reform, the Government’s proposals must be comprehensive. In the discussion of social care, all too often there is a failure to acknowledge the diversity of the sector and a dominant focus on care for older people, which ignores the needs of working-age adults, who account for almost half of all spending on adult social care. It also ignores the unregulated provision in which much care and support is delivered, and the needs of unpaid carers, who save the economy a colossal £132 billion each year.

We need a social care system that makes high-quality care and support available to everyone who needs it across a wide range of different settings. Although I hope the Minister will respond on the urgent need for long-term reform, there are also some very pressing short-term concerns that are important for the social care sector right now. The first is the question of additional funding for infection control. Social care providers have faced huge additional costs as a consequence of the need to use personal protective equipment and employ additional staff to cover for sickness absence, or to avoid agency staff travelling between care homes. Despite the anticipated release of covid restrictions in June, it is highly likely that the need for enhanced infection control in care homes, and for domiciliary care workers, will continue. However, the current funding allocation runs out in June. Can the Minister confirm whether ongoing funding will be provided for infection control in care homes beyond June?

Secondly, many care providers have raised with me the very restrictive nature of the 14-day quarantine requirement for residents who leave care homes, which means that if a resident leaves a care home, even for only a few hours, they have to quarantine for 14 days. Having entirely failed to protect care homes from coronavirus infections at the start of the pandemic, the Government are now applying a much more restrictive standard to care homes as restrictions are lifted elsewhere. Can the Minister please explain under what legislation the guidance could be enforced? What are the implications for the deprivation of liberty?

Importantly, what will be the implications for care home residents who wish to vote in local elections on 6 May? Requiring residents to isolate for 14 days after attending a polling station will surely deter many from exercising their democratic right to vote. In anticipation of the guidance, there has been no dedicated effort to encourage residents to vote by post, or to make them aware of the implications of it, and it is now too late to sign up for postal votes. Will the Minister consider moving to an approach based on testing, vaccination, social distancing and PPE in order to enable care home residents to leave their care homes for voting and other essential purposes?

In conclusion, I thank each and every social care worker for their immense contribution during the past year of the coronavirus pandemic, and I remember each worker, care home resident or vulnerable adult whose life has been lost. I pay tribute to the scientists and NHS workers who have delivered the vaccine roll-out with such rapid speed, so that we can now see the beginning of the end of this terrible pandemic. However, acknowledging the immense contribution of the social care sector at the frontline of the coronavirus pandemic can be done properly only by making a firm commitment on the funding and reform that social care so desperately needs, and I hope the Minister will take the opportunity to do that today.

Photo of Barbara Keeley Barbara Keeley Labour, Worsley and Eccles South 3:29 pm, 22nd April 2021

It is a pleasure to speak in this important debate with you in the Chair, Mr Twigg. I congratulate my hon. Friend Helen Hayes on securing it and on the way she opened it. It is the first time I have spoken in a Westminster Hall debate in the Boothroyd Room as well.

The covid-19 pandemic has exposed the failings of our social care system. With more than 30,000 deaths of care home residents, the care sector has been hit very hard over the past year. Of course, it is not just care home residents who have died from the virus. We know that people with learning disabilities were around six times more likely to die from covid-19 than the general population. Every single one of those deaths was a tragedy that we must never forget.

Beyond that appalling death toll, there are staff who worked far beyond what would normally be expected of them, many of whom have also been hit hard by the deaths of people they have known for years. There are also care home residents who have been cut off from friends and family for months on end and other care users who have gone without vital support in order to avoid contracting covid.

The Government made the fundamentally flawed decision at the start of the pandemic to allow local authorities to overlook their obligations under the Care Act 2014. While these social care easements were used by only a handful of local authorities, and have now been withdrawn, the reality is that many people using social care saw their services cut back.

Over two thirds of people with learning disabilities reported that they had their care packages cut in the first wave of the pandemic. The vast majority of these will not have lived in areas that implemented Care Act easements, meaning they should not have seen changes to their care packages. As a result, four out of five family carers have been forced to take on more unpaid care for the person with a learning disability. Nearly nine out of 10 people with a learning disability have not had all their social care reinstated, so their family members and carers are still having to increase the care they give.

Where services were still provided, restrictions on visiting often failed to consider the damage that isolation does to people’s wellbeing. I accept that there were times when visiting had to be paused, but the use of blanket bans and maintaining restrictions beyond those imposed on the rest of society left residents isolated and seriously impacted their wellbeing. The issue is exemplified by the current guidance on visits out of care homes, as referred to by my hon. Friend.

The Government have finally relented on allowing the over 65s to go on visits out of their care homes, but they are expected to isolate for two weeks on their return. As I raised with the Secretary of State for Health and Social Care this week, a traveller from Brazil or India must isolate for only 10 days when they arrive in this country. Are we seriously saying that an older person on a visit, who sits outside for an hour or two with a family member who has tested negative, is more of a threat than someone coming from a country that is seeing a hundred times more covid cases than the UK? In addition, as my hon. Friend rightly raised, the issue of residents having to isolate after voting must be sorted out before election day.

Earlier in the pandemic, there was a blanket ban on visiting for people with learning disabilities living in care homes or those living in supported living settings. Many of the people covered by these bans lived alone in their own homes, with carers coming in to support them but, because of the lack of clear guidance, they were told they could not form a support bubble and they could not have visitors. This was disproportionate and it risked creating closed cultures in some services, because neither family members nor Care Quality Commission inspectors were able to visit to monitor the development of any inappropriate practices. At its worst, I heard from the mother of a young person with learning disabilities that the social worker had to ask care staff to bring the young person to the window to prove he was still alive.

I am glad that we have now moved away from the position of blanket bans, but people living in care homes and in supported living settings need a concrete reassurance that they will never again be denied fundamental rights, such as contact with family members. If this means implementing robust testing procedures for some time yet, that is what should happen.

I want to turn to care staff, whose work and commitment have gone above and beyond over the last year, because they deserve better support. As my hon. Friend said in her opening speech, at the start of the pandemic we heard about care home staff leaving their families to move into care homes full time, so they could ensure they did not unwittingly bring in the virus. Care staff also took on additional roles, because NHS staff switched to online consultations or were unable to visit due to ongoing covid outbreaks. Much of what care staff did was involved with end-of-life care.

The Select Committee on Health and Social Care heard from one member of care staff who told us this:

“We have done things that are on a par with other medical professions…we have a duty to care, and we do the job for a reason.”

If the crisis of the pandemic showed us anything, it was that without the hard work and commitment of care staff our care system simply would not work. We must remember the 470 social care staff who died from covid, including Jane Rowbotham, a care home manager in my constituency. Despite all that, care staff remain chronically underpaid and undervalued, with poor recruitment and retention rates. There is, rightly, outrage at the idea that NHS staff will get a real-terms pay cut this year, but most care staff will not get any rise either. The reality is that most of them will be asked to accept a pay freeze, at best, despite rising workloads and all the additional responsibilities.

There are 112,000 care job vacancies, and the turnover rate is 30%: those workforce issues cannot be allowed to continue indefinitely. Without extra funding, care providers are not in a place to provide extra support to their staff. Since the start of the pandemic they have taken on extra costs, from extra PPE to deep cleaning, while there has been a drastic decline in the number of care home residents. They were struggling to make ends meet before, and the additional funding provided by the Government simply has not been sufficient to meet their needs.

The Local Government Association estimates that adult social care services have faced additional costs of £6.6 billion in tackling the pandemic, with PPE alone costing more than £4 billion. The National Audit Office has reported that many local authorities will have to rely on reserves to balance their budgets this year, and there is little confidence about the setting of budgets beyond that, to meet needs that have increased during the pandemic.

It is clear that since the emergence of the virus last year, the social care sector has often been overlooked by the Government. Ministers claim to have put a protective ring around care homes at the same time as hospitals were actively discharging covid patients into care homes, without testing them. Care homes, in turn, were not resourced for the measures that they needed to control an outbreak. Residents have gone without contact with their friends and families because of limits on visits, which still involve a longer quarantine period for a care home resident who spends an hour sitting outside with a family member than there is for an international traveller coming back from a red-list country. Staff who have done so much to keep the care system going are rewarded only with the offer of a CARE badge. There is no pay rise or bonus as offered to care staff by the Welsh Labour Government.

All that is not good enough. When the Minister responds to the debate, I hope that we shall get more than warm words for social care. We need solid commitments. The pandemic has to be a turning point in the way we treat care staff. In the past year we have all seen that the work done by care staff—whether in a care home, providing domiciliary care, or in supported living—is every bit as important as the work done by NHS staff. It is time for social care staff to have parity of esteem with NHS staff, and for a workforce strategy for social care that has better pay, conditions and training for the staff who have given so much. It is way past time for the Government to take action to fix social care funding as they have promised to do repeatedly in the past 10 years.

Photo of Damian Green Damian Green Conservative, Ashford 3:37 pm, 22nd April 2021

It is a pleasure to serve under your chairmanship, Mr Twigg. As others have said, this is my first speech in the Boothroyd Room, although I reflect, as I look at the wall and see those steely but friendly eyes staring at me, that I have been around long enough to remember that happening live in my first Parliament, with Madam Speaker, as she then was, in the Chair. I am grateful to Helen Hayes, my co-chair of the all-party parliamentary group on adult social care, for obtaining the debate. I should declare that I am chairing an investigation of social care by Public Policy Projects.

There are two halves to the debate. Obviously there is the covid-19 aspect, but there is also the question of the future of social care more generally, and they clearly come together in important ways. But I shall start with the specific covid-19 aspects. I agree with much of what the hon. Member for Dulwich and West Norwood said. In particular, urgent action is required to facilitate voting by people in residential care homes, on 6 May. That obviously needs to be done in the next few days, and I hope that the Minister can take that message away from the debate.

We have seen the most terrible year ever in care homes —the figures have been put out already, so there is no point in my repeating them. It has been terrible not just for covid victims but for other residents and relatives who have seen the terrible toll of what has happened inside care homes. Happily, we have now moved on from the worst days of this time last year, and the current covid-related issues in care homes tend to relate to access for visitors and the opportunities for residents to make visits outside. Both are hugely important issues for the wider mental health of those living in care homes.

I have a lot of sympathy for my hon. Friend the Minister, for other Ministers and, indeed, for care home managers. The paramount concern must be safety at all times and I can see that there is an extremely difficult balancing act. The solution surely lies in vaccination—not just of residents, but of staff. Through discussions at the APPG working group that we have heard so much about already, I am aware that there is a great disparity of view about how best to encourage vaccination take-up among care home staff.

People argue strongly that threatening to make vaccination compulsory might not be the most constructive approach, and the Government are consulting on that. I await the results of the consultation but, whatever the best system, it is imperative that the percentage of those who work in care homes and who have daily contact with the most vulnerable people in the country should be higher than the national average and not lower, as it is in too many places. That is an urgent aspect of the current situation.

I have fallen into talking about care homes, but domiciliary care is equally important. People move from house to house where there are vulnerable people so the same thoughts apply to that sphere. Those who look after a loved one—“unpaid carers” in the sector jargon—are equally important, and they should be vaccinated as well. I urge my hon. Friend to move fast and get our care workers vaccinated as quickly as possible for the sake of those who need care as well for the comfort of loved ones who will then be able to visit. That will also help to create a sense of normality for those who will then be able to leave the care home that they may have felt trapped in over the past year. That is clearly an important mental health issue.

The crisis over the past 12 months has shone a fierce light on residential social care and has drawn public attention to it in a way that has never happened before. It could scarcely have happened in more tragic circumstances, and the only sliver of consolation from the awful death toll has been the developing consensus that we simply cannot go on putting sticking plasters on to an increasingly fragile system.

It is getting on for a quarter of a century since the first in a list of Prime Ministers said that social care was an urgent issue that needed addressing. I have done some research and I think Tony Blair said that at a Labour party conference in 1997. All his successors have agreed with him, but the problem is that none of them has yet met words with action. That is not for the want of trying.

Under Gordon Brown, Labour produced proposals for a national care service that foundered when it was dubbed a “death tax”. David Cameron put through the Care Act 2014 and a version of the Dilnot proposals. Shaky Government finances meant that was never implemented. In 2017, a new version was proposed by my right hon. Friend Mrs May. It was dubbed a “dementia tax” with not great political results. Here we are in 2021 without a solution on the table and the problem is still with us. Later this year, we are promised a sustainable solution in the comprehensive spending review. Let us hope that we see it.

There are many problems to be solved, and some have been mentioned by previous speakers. At the root of them all is funding. The Health and Social Care Select Committee estimates that £7 billion extra is needed to put the system on a sustainable footing. The most intractable problem, as it has been over the past quarter of a century, is how it is raised. If it is all raised from taxation or national insurance, working-age people will, by and large, end up paying for their own care, perhaps later in life, and that of their parents’ generation. That will rightly seem unfair to them.

More promising models offer a mixture of extra public spending and more contributions from individuals—through an insurance system, through a Dilnot-style system or through variations of those models. I argued in a paper for the Centre for Policy Studies that we should look to the pension system for an example of universal state provision being successfully supplemented with private savings. As we have seen with pensions, we have established cross-party consensus under Governments of different parties.

Even when the Government come to a conclusion on how to find the extra money needed—let us hope that it is not from council tax, which is not suitable for funding care—there will be other intractable problems, including workforce planning. The demographics will dictate that we need more workers, so we must make it a more attractive sector to work in. Pay levels have already been mentioned, but the development of a proper career structure for care workers—it can be seen in the NHS, but it is much less easy to see in the care sector—is hugely important.

So much technology of all kinds is available that would improve the daily lives of those receiving care, but I fear that there is no discernible strategy for introducing and experimenting with it.

Housing is a key issue. If we built differently we could keep far more people in their own homes longer, which would make them happier in themselves, most importantly, and be less expensive for the system. I agree very much with Anchor, one of the providers, which says that there should be changes in the planning system that include older people’s housing in local plans and the creation of a new planning classification for retirement communities. That and other ideas are very worth considering.

Finally, and perhaps most importantly, there is the whole issue of what integration we want of the care system and the NHS. I am delighted that the Government produced their recent paper on integrated care systems. It will not be easy to make a reality of that, but it will be absolutely vital.

I make a plea for two things, the first of which is that the voice of the care sector is heard not just in debates on ICSs but inside ICSs when they are introduced. At present it is not clear from the White Paper that that would happen. As a subset of that, simply having local authorities, vital though they are, around those ICS tables is not enough. There are many independent, third sector and profit-making providers whose voices need to be heard.

Secondly, I completely welcome the long-term plan for the NHS—the 10-year plan—but equally it is important to have a 10-year plan for social care that fits with it so that it is seen as a system on its own. It clearly has to mesh very closely with the NHS: it has as many and as complex needs as the NHS and ought to be treated as just as importantly.

I am aware that that is a formidable set of challenges, but 25 years is too long for reaching a decision about how to tackle them. I hope and profoundly expect that this is the year when we will finally see determined and sustainable action on this front.

Photo of David Warburton David Warburton Conservative, Somerton and Frome 3:49 pm, 22nd April 2021

It is a delight to be able to participate in this important and timely debate, and to do so under your chairmanship, Mr Twigg.

I thank my right hon. Friend Damian Green and Helen Hayes for securing the debate. As a vice-chair of the all-party group on adult social care, I must pay tribute to both Members for their commitment in this area and their leadership of the APPG.

Care workers have made an extraordinary contribution, particularly through the hugely difficult circumstances of the past year, doing all they can to help people to live comfortably, safely and with dignity up and down the country. Here in Somerset, at the onset of the pandemic, I had the privilege of working with Gracewell of Frome care home, and I have to say that the dedication and professionalism of Jemma Griffiths and her staff have been tremendous.

Care workers such as those at Gracewell and in similar settings across the country could reasonably be called the unsung heroes of this crisis. They have worked throughout to keep the most vulnerable among us shielded from the virus, and to provide their residents with comfort when their families and friends have been unable to visit them. I hope that today’s debate is also the beginning of our showing appreciation for the vast number of people who work across social care settings: the caterers, the cleaners, the drivers, the porters, the assistants who have supported people in their own homes, and of course the unpaid carers, supporting their own loved ones.

However, sadly, the pandemic has shone a spotlight on the fragility of our social care system, which is all too harshly demonstrated by the shocking loss of life in our care homes that we have been hearing about since last March. Although covid has perhaps made social care reform unavoidable, it is clear that many of the issues it has exposed have existed for years, if not decades. We see this through staffing shortages, with Skills for Care research highlighting over 100,000 vacancies across the social care sector at any one time, and we see it through the impacts on the NHS, with lack of capacity in the social care sector causing too many people to remain in hospital unnecessarily. Surely, this is the opportunity to learn the difficult lessons from this period and create a sustainable future for social care.

Let us be clear: that sustainable future for social care is dependent on sustainable funding. The LGA estimates that adult social care services face additional costs of over £6.6 billion in tackling the pandemic. Increased staff, personal protective equipment, cleaning and overheads have been the areas of most pressure, and while the social care grant has been extremely valuable, I am concerned that it is not enough to address the situation, or indeed the future. I am sure that the Minister will comment further, but Mencap’s figures suggest that at least an additional £3.2 billion of funding is needed to stabilise the social care sector before a longer-term settlement can be achieved.

Over the past year, as we have been hearing, we have all been concerned about the situation around visitation and the confusing policy advice there. Obviously, since 12 April, there have been welcome changes to the guidance, but safe access for social care workers to visit people in care and health settings continues to be difficult, even with the successful rolling out of testing and the vaccine.

Should—perish the thought—new restrictions be required in the future, I very much hope that social care settings will get quick and clear guidance from the very start; as with so many sectors affected by the pandemic, this is really about certainty. One thing I hear again and again from people in the social care sector is the perceived lack of appreciation for what they do. We have all rightly praised the NHS throughout the pandemic, but parity of esteem for the social care sector is vital. If we are to see social care improve and provide better outcomes and better health, it must not be the forgotten frontline.

As such, I very much support a comprehensive social care workforce strategy, much as we have a people’s plan for the NHS, to drive forward skills training, professionalism and better pay and conditions for our social care workers. Such a strategy should be anchored in the vision of improving the quality of life for the people who access care and support. With the introduction of integrated care systems in England, this is more important than ever. Truly integrated care means that we need a truly integrated approach.

I look forward to hearing the Minister’s comments on such a scheme and a funding boost for social care, along with, of course, a long-term and sustainable funding solution that is equitable and fair for all.

Photo of David Simmonds David Simmonds Conservative, Ruislip, Northwood and Pinner 3:55 pm, 22nd April 2021

It is a pleasure to serve under your chairmanship, Mr Twigg.

I commend Helen Hayes and my right hon. Friend Damian Green for securing this debate, and I particularly commend my right hon. Friend for his work to develop long-term policy solutions for many of the challenges that we see, which are not new but which have been brought into sharp focus by the experience of covid and its impact across the social care sector. We have all seen large numbers of constituents, for example, who have been enormously distressed by the restrictions on care home visits, which has had a hugely significant impact, and it is welcome that we are able to see a lifting of restrictions, so that families can get together at long last.

However, when we look across the whole of the UK, we recognise that even in places where there is a relatively high level of demand being placed on the care sector, less than one in five of the population will make use of it during their lifetimes, including children’s social care, adult social care and social care for older people. It is a sector that is often not well understood. In fact, because most people do not engage with it during their lifetime, unlike the NHS, the police and other emergency services, people often do not appreciate how it works or indeed recognise that for most top-tier local authorities—those with social care responsibilities—social care will consume around 70% of their budget. It is far and away the biggest area of local authority expenditure in England.

I would like to draw the Minister’s attention to the work of Sir Paul Carter, formerly the chairman of the County Councils Network and the leader of Kent County Council, who has been looking internationally at models of care, particularly for older people, and ways of funding care that represent a move towards sustainable and long-term funding. This is a topic that I will come back to my closing remarks, but when 70% of the typical local authority budget is being spent on care, there is clearly a serious risk that unless we find a long-term solution, it will consume the rest of the budget.

Many of those other services, such as libraries, parks and leisure services, which support the wellbeing of the wider community and in many cases represent the infrastructure that our communities need, will genuinely be in financial peril unless we find a long-term financial solution. Indeed, the only area of local authority expenditure to have increased in the last decade is expenditure on children’s social care, which has been achieved largely at the expense of other areas of local authority expenditure, rather than through tax rises.

A number of ideas have been put forward. I know that many in the local government sector—I speak as a vice-president of the Local Government Association—have welcomed the opportunity to raise a council tax precept specifically for social care. However, even when I consider my own two local authorities, which are London boroughs, there is enormous variation within the same type of council and within the same type of city in what that precept can contribute to boosting social care budgets. It ranges from the maximum precept being implemented —in the City of London, an additional 0.02% on the budget—to the other end of the scale, in the London Borough of Richmond, where much more expenditure is raised directly through council tax and where there is an additional 1.8% net. When we take into account the variations across the country, it is clear that precepts are not a long-term solution to social care funding. We need to find a different way of looking at this issue.

The second issue, which seems to me absolutely critical, is that we need to consider the success or otherwise of the joint working arrangements put in place under schemes such as the better care fund, whereby the NHS and local authorities come together to manage local services. When we look at those ventures, it is very clear that it is the local authority-led elements of them that have consistently delivered against the targets that they have been set and the outcomes that we are all seeking to achieve. The NHS has found it considerably more challenging.

That demonstrates that we need to look at a local authority-led model for social care, because it is already clear and established that it is more efficient, more focused on delivery for our residents, and more likely to achieve the outcomes that we want to see. Because the vast majority of social care for children and adults of working age is well outside both the remit and the capacity of the NHS—indeed, it is not something that would normally be a priority for the NHS—it is clear that that bigger picture needs to remain firmly in view as we look at a long-term solution. A key element of likely success in social care reform will be in ensuring that it is managed and controlled by local authorities, who are in the best position to deliver against that.

Moving to conclusions, it is clear that in order to be effective and to address the issue around the discharge of patients from hospital, which causes such concern, a new model of care needs to have a very direct form of input, particularly from acute NHS services when it comes to the discharge of patients from hospital and rehabilitation services, which are a big part of this. We also need to ensure that general practitioners are able to work closely with the system so that the needs that they see emerging among patients in their surgeries can be taken into account. What we need most is a stable and consistent funding model, and there have been different attempts at developing that.

In his recent work, Sir Paul Carter looked at how the German operation is funded and structured through a form of social insurance. To an extent, what matters is not that we try to find a perfect solution. We need a solution that providers of social care and local authorities can rely on to ensure stability in the system and to avoid either the large-scale collapse of parts of the social care system, as we have seen with some providers, or a continued shortfall between what people need and expect, and what local authorities and their partners in the NHS can provide.

It seems clear from everyone who has spoken today—I am sure the Minister has grasped this message—that stability and consistency of funding are critical to provide a long-term solution for social care in England and the wider United Kingdom.

Photo of Martyn Day Martyn Day Shadow SNP Spokesperson (Public Health and Primary Care) 4:02 pm, 22nd April 2021

It is a pleasure to take part in today’s debate, Mr Twigg. I am grateful to Helen Hayes for securing it. May I start by paying tribute to all the care staff who have worked so hard during the covid crisis, tackling issues on the frontline and coping with the loss of residents to the virus? I extend my deepest sympathy to all who have lost loved ones.

Members will be aware that social care is a devolved matter, and in Scotland we do things a little differently, which means I often feel like a foreign observer during such debates. However, there is no doubt that we have faced many of the same challenges over the past year. The challenges of covid have been quite unprecedented in the sector. I have commented in a few debates that there are often lessons that we can learn from each nation and good practices that can be shared. I hope that on this issue that proves to be the case.

There are lessons that we must learn for the future from our covid experiences. We know from the Office for National Statistics data for England and Wales and the National Records of Scotland data that our nations pretty much experienced the same rates of care home deaths per head of population. Such deaths account for approximately a third of all covid-19 deaths, and that represents a national tragedy. Undoubtedly, hindsight tells us that there are things we would have done differently if we had known then what we know now, but real-time decisions are made without that luxury. Instead, we have to be content that the decisions taken were thought to be the best at the time, and we must learn from the experience. I welcome the Scottish Government’s commitment to hold a public inquiry into the handling of the pandemic by the end of this year.

On a positive note, Scotland has achieved almost complete vaccine uptake among care home staff without making the vaccine compulsory, which I think we can all welcome. It can be done. Like the NHS, social care has faced huge pressures during the covid pandemic. In Scotland, the SNP Scottish Government have taken action during the covid outbreak to support the social care sector and its workforce. Going forward, we are committed to creating a national care service, increasing social care investment and scrapping non-residential care charges to ensure a rights-based approach to care.

Throughout the pandemic, the Scottish Government continued to prioritise the health, safety and wellbeing of their health and social care workers. That included working with partners to ensure a range of wellbeing and psychological support, with measures such as the national wellbeing hub, a national 24-hour phone line for NHS and social care staff, and committing £5 million to establish a health and social care mental health network to enhance existing support and provide more funding for local support.

Social care providers in Scotland can currently claim back PPE costs over and above their usual amounts due to the pandemic, and can access local PPE hubs for emergency PPE supply if their existing supply routes fail. That support is available to social care providers across the sector, including unpaid carers and personal assistants. Those arrangements, introduced in March 2020, were due to expire in March this year but have been extended until June.

The most significant changes going forward, though, will come from the findings of the independent Feeley review of adult social care in Scotland, which contains 53 recommendations for the future of social care provision. The SNP is committed to implementing the recommendations of the Feeley review, including scrapping non-residential social care charges. The report, which was published on 3 February this year, provides a foundation to enhance adult social care provision across Scotland.

This independent review has found many aspects of Scotland’s adult social care system that are worthy of celebration, such as the introduction of self-directed support, the Carers (Scotland) Act 2016, and our commitment in legislation to integrate health and social care. Scotland is proud to be the only country in the UK with free personal care, which was extended in April 2019 to all those under 65 who need it.

I believe that social care services, just like healthcare services, should be provided on a truly universal basis, free at the point of use. An SNP Government will abolish all non-residential social care charges for those who need support. Health and care integration has been progressing in Scotland since 2014, and the SNP Scottish Government’s commitment to develop a national care service will ensure equity across the country.

On 16 February, the Scottish Parliament voted in favour of a motion that commits to establishing a national care service in law, on an equal footing with NHS Scotland, to provide national accountability, reduce variability, and facilitate improved outcomes for social care users across the nation. The creation of a national care service will also involve reviewing the number, structure and regulation of health boards and other related delivery services to remove unwarranted duplication of functions and make the best use of the public purse.

Social care staff in Scotland are already paid better than those in England and Wales, and the SNP has pledged to introduce a new fair national wage for care staff and national pay bargaining for the sector. For their extraordinary service in the battle against covid, social care workers were included by the Scottish Government in the £500 bonus thank-you payment.

The £500 thank-you payment is for Scotland’s NHS and social care workers employed between 17 March last year and 30 November, including staff who have had to shield or who have since retired. It includes final year nursing students who worked on temporary contracts during the pandemic—like all staff, it will be paid pro rata—as well as community pharmacists in Scotland, NHS bank and NHS locum staff, who work on NHS contracts at NHS rates of pay, and staff employed on a seasonal basis for GPs, dentists, pharmacists and optometrists.

That investment of around £190 million will see nearly 400,000 staff gain some benefit from the payment. The SNP has repeatedly called for the UK Government to allow the payment to be exempt from income tax. Sadly, the ability to exempt the bonus in that way is not within the current powers of the Scottish Government; it is a power that we shall soon have with independence. The UK Government should follow Scotland’s lead and make a commitment to a national care service for England.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health and Social Care) 4:09 pm, 22nd April 2021

It is a pleasure to serve under your chairmanship, Mr Twigg, and very nice to see so many people present in person. One of the things that we have all missed during this pandemic is human interaction, possibly even in Parliament.

I congratulate my hon. Friend Helen Hayes on securing this debate and on her brilliant speech, every word of which I agree with. I thank her and Damian Green for their work on the APPG. Every week, I have read the readout of their discussion, even if I have not been able to attend, and that real-time information has been hugely important. I also pay tribute to my hon. Friend Barbara Keeley, who was the shadow Minister for Social Care before me and from whom I have learnt a great deal over many years.

I will say something about the impact of the pandemic on the users of services, staff, families and the wider community, who have not been touched on so far. I will also talk about the underlying reasons why we have failed to prioritise and secure longer-term reforms to social care. We cannot deal with a problem unless we understand why it is there; that is how we get progress.

As other hon. Members have said, the emerging tragedy in social care over the course of this pandemic will be etched on all our brains for the rest of our lives. To see 41,500 care home residents dying from covid-19, including those residents who ended up dying in hospital, has been brutal for every single one of those people, their families and all the staff who have gone through unimaginable horror caring for people at this difficult time.

The sad reality is that the proportion of care home residents who have died in England is higher than in almost any other country that we have data for, especially in Europe, where it is surpassed only by the proportion who died in care homes in Slovenia, Belgium and, unfortunately, Scotland—despite what Martyn Day said. Scotland has had one of the highest rates of care home resident deaths. That is a serious problem. I will come on to why, whatever Ministers said, I think that a protective ring of steel was not put around care homes. That is related to the deep-seated problems and our fundamental challenges. We must ensure that it never happens again.

People living with dementia have been particularly badly hit by the pandemic. A third of all covid-19 deaths have been of people living with dementia. Also, the deaths of people with dementia even where covid-19 has not been present have been significantly higher. I will say something about this later, but I think the fact that so many people in care homes have been prevented from seeing their loved ones means that those with dementia have gone downhill fast. When people lose their memory, which is what dementia is, their family is their memory. No matter how hard care home staff try, family are the ones who know what films people liked or what music they liked to play, and without their absolute involvement and interaction, we have seen many care home residents with dementia go downhill fast.

I also want to touch on a point made continually by my hon. Friend the Member for Worsley and Eccles South: the impact of covid-19 on people with learning disabilities. They are six times more likely to die than the general population and, horrifically, for those aged 18 to 34, they are 30 times more likely to die. To be honest, however, that should come as no surprise to us, because we know that people with learning disabilities have far worse health outcomes and are more likely to die early because of their lack of proper access to care.

Everybody has rightly paid tribute to the amazing work of care staff, who have given more than almost anybody during this pandemic. Tragically, they were twice as likely as the general population to die from covid-19 during the first wave. That presents two really big issues.

There was an appalling lack of access to PPE, especially in the first wave. I met frontline care workers who told terrible stories of having only one mask to last the whole day, from client to client, when seeing clients with dementia, who cannot help but spit on to the mask when they are talking, so the care worker thinks, “I haven’t got another mask to see my next client.” A survey by GMB found that 85% of frontline care workers said that they were worried about the risks to their own health and that of their families, and that one in five thought about quitting cause of the lack of PPE.

That has been compounded by the low pay and poor terms and conditions of frontline care workers. We have heard time and again that many workers who needed to self-isolate or shield were forced to take unpaid leave or rely on statutory sick pay, leaving them desperately out of pocket, unable to pay their bills and facing an awful choice between going to work or being unable to put food on the table. A Unison survey found that those are absolutely essential issues that must be addressed. One care worker said:

“I was Covid-positive after contracting it at work and was off for three weeks. I have a mortgage to pay and bills, and I don’t know how I’m expected to survive. I put my life on the line, survived and was repaid with SSP.”

Three quarters of frontline care workers do not make the real living wage. Many do not even make the minimum wage at the end of the week because they are not paid for travel time between clients. We cannot deliver a better system of social care without transforming the pay, terms, training and conditions of the care workforce.

On families, there are two issues. One is unpaid family carers, who have done so much more to care for their elderly or disabled loved ones during this pandemic. There were 9 million of them in the UK, but since the pandemic struck, there have been an extra 4.5 million—it is astonishing that we have not heard more about that during the debate. They are providing even more care than usual, without breaks, and their own physical and mental health has suffered as a result. Families are as important as the paid workforce in delivering care in this country. We need a new deal—a partnership between families and the Government—to support those carers in doing their best to look after their loved ones.

We then have the families who have been banned from seeing their loved ones in care homes, and who are now also unable even to take their loved ones out for a walk or a cup of tea, because they would have to self-isolate for 14 days. We have to completely rethink that. Since June, we have been arguing that families should be treated as key workers and have access to all the testing, PPE, vaccinations and so on, so that they can safely visit their loved ones. That is not just a term or a gimmick, however; they actually are key workers. We cannot have good-quality care for older or disabled people without families’ involvement.

I urge the Minister, as I have done many times when discussing this topic, to have a rethink about this. The guidance still is not working—it is wrong on the 14-day self-isolation—and we may have to look at legislation to enshrine the rights of care home residents. They are not prisoners. Quite frankly, if we all think that, when we end up in a care home, we will be banned from seeing our family and will not be allowed out, what kind of future is that? It will be a future that we fear, rather than a future for which we look forward to getting older, and that must change.

On the wider community, one of the positive things from the pandemic—I am very proud of what has happened in Leicester, the city that I represent—is how many voluntary groups and mutual aid groups have sprung up to try to do things such as helping older people with shopping, delivering it quicker than either the local authority or the private sector ever could. That support for the wider community—ringing older people to help them if they are isolated—has got to be part of our future social care system, too.

Let me move on to why we have seen the problems that we are all relating here. The immediate and glaring issue, as the Alzheimer’s Society has said, of why we have seen such problems in the care sector, is that the pandemic struck at a time when social care was already overstretched and undervalued. Local authority care budgets have been cut by £8 billion in real terms since 2010 and that has pushed many to absolute breaking point. It is not morally right, but it does not make economic sense either, because if staff are not paid properly and there is high turnover and vacancy rates and family carers are not supported and their health suffers and they end up in hospital, that costs us all far more.

It is also the failure to put in place long-term reforms, as Damian Green said. Why is that the case? It is a big challenge, but it is not rocket science, to ask for older and disabled people to live as normal a life and as full and fulfilling a life as possible, with help to get up, washed, dressed and fed, maybe go to the shops, with help for a disabled person to live independently and maybe have a job. It is not that complicated, yet we have ended up in this crisis. Why?

First, when the NHS and the wider welfare state was created, average life expectancy was 63. Now, it is 80. We did not live in a world where people lived for so many years, and so we have been scrabbling to catch up ever since, with a fragmented and piecemeal system. Secondly, in many ways we have left it to families—“This is a family issue; families should look after elderly or disabled relatives.” Yes, and they want to. They want to do all they can, but they need help and support, especially in a world where women work; they want to work and balance their family lives. Thirdly, it is about caring and caring is women’s work—undervalued, underpaid and yet some of the most important work in our society.

What that all adds up to is a failure to understand that a third of our lives will now be lived aged over 65. We have got to transform society—not just the care sector, but housing, transport and planning—because getting older should be something that we look forward to with hope and optimism, not fear. It is my lovely mum’s birthday today. She is so worried about the pandemic, but I am afraid, when I was discussing this debate, she said, “You know what, Liz? You know what we feel? At best, ignorable; at worst, expendable.” That is not a country that any of us want to live in.

The legacy of this pandemic must be to transform services and support so that every older and disabled person can live the life they choose. It is politically controversial and my strong advice to the Government would be to bring forward proposals early on, because the closer we get to an election, the worse it will be. The Labour party was accused of a death tax; the Conservatives have been accused of a dementia tax. In the end, it is not us who suffer. It is the people who use services and their families.

We need a long-term settlement for older and disabled people that pools our resources and shares our risks and has a fair balance of funding across the generations. That is surely within our grasp. I know Opposition Members will continue to do everything they can to secure a better future for all.

Photo of Derek Twigg Derek Twigg Labour, Halton

I remind the Minister to leave a few minutes at the end for Helen Hayes to wind up.

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care) 4:23 pm, 22nd April 2021

I will do so. It is a pleasure to serve under your chairmanship, Mr Twigg. I wish the shadow Minister’s mother a happy birthday today.

I thank Helen Hayes and my right hon. Friend Damian Green for securing this debate on social care and covid and for the work they do as co-chairs of the APPG on adult social care, bringing the sector together and being a voice for it in Parliament and beyond.

As the hon. Lady and my right hon. Friend said—as, in fact, all speakers today have said, and as we all know —the pandemic has been cruel to those who receive social care, especially those living in care homes around the world, here in the UK, and indeed in England. Sadly, both residents and care staff have lost their lives, and each one will be missed by friends, family, and those who love them. I thank those working in social care—staff in care homes, home care workers, those supporting people in extra care and supported living, personal assistants, social workers, and millions of unpaid carers as well—for all they have done during the pandemic, and are continuing to do now, to care for those who rely on their care and could not live without it.

Members have spoken about the many challenges the sector has faced during the pandemic. I want to outline some of the things that the Government have done to support social care, with a level of intervention—a level of support—that is unprecedented for social care, and rightly so in the circumstances of the pandemic. First, the hon. Member for Dulwich and West Norwood spoke about the extra costs that social care has faced during the pandemic. We have put in £1.8 billion of specific, ring-fenced covid funding for social care during the pandemic, including £1.3 billion for infection control measures, and providers have told me what a huge difference this support has made to them and how essential it has been all the way through the pandemic.

Secondly, the Government have stepped in to provide PPE to the social care sector, and PPE has been available free for many months via a portal to meet the covid needs of social care providers on demand. Over 2 billion items of PPE have been supplied to the social care sector, and the Government have committed to continue PPE supply through to March 2022.

Thirdly, social care has been prioritised as our testing volumes have increased. Last summer, we introduced weekly polymerase chain reaction testing for care home staff, and since December, that has been supplemented by twice-weekly lateral flow device tests. That has made a difference, because we can not only quickly identify when a staff member may be covid positive but, through the introduction of the LFD tests, we are able to identify whether a member of staff is covid positive before they set foot in the care home. During this time, we have sent out over 28 million PCR tests and 47 million LFD tests to the social care sector across care homes, home care, supported living, and other parts of the sector. We have also made rapid tests available to visitors, supported by £288 million of funding for the staff costs involved in that testing, to help people see loved ones. I will say more about visiting in a moment.

Fourthly, many hon. Members have spoken about the impact of the pandemic on the social care workforce. Again, we cannot thank care workers enough for what they have done, and how they have gone the extra mile time and again. Through the virtual visits I have made to care homes and the conversations I have had, I have seen what staff have done, particularly to step in and support residents at a time when visiting has been restricted.

I also know the difficult experiences that some care workers have been through. We have specifically advised care providers to use some of the funding for paid sick leave for social care staff who have had to isolate due to covid. We have also put in place mental health support for the social care workforce, seeking as far as we can to mirror the mental health support offer to NHS staff, and we will continue to see how we can support staff through the mental health impacts of the pandemic.

As hon. Members have said, we know that there are workforce shortages within social care, and at times covid has made that harder, with staff rightly taking time to isolate. Recognising that, we provided £120 million of funding for the workforce capacity fund, which was passed to local authorities to boost staffing for the sector during the second wave.

To increase the voice of the social care sector and to give further leadership—particularly clinical leadership—to the social care workforce, we appointed the fantastic Deborah Sturdy as the chief nurse for social care. She is already doing brilliant work with the sector and the workforce, and contributing to plans for the workforce of the future.

To increase our understanding of the social care situation on the ground, we created a social care data dashboard as a single point of information for the system. We came into the pandemic with relatively small amounts of timely data about social care; as hon. Members know, it is a highly fragmented system, with over 25,000 different providers. We have built a way of having up-to-date information and self-reported data from providers, which has given us truly valuable information to which local authorities also have access. It gives a good sense of what has been happening on the ground.

We have also established a regional assurance team for social care, as this is now the Department of Health and Social Care. They are a group of people with great experience in the sector who have been able to reach out during the pandemic, working with local authorities, directors of public health, providers and others, to understand some of the challenges being faced and provide more localised support.

On visiting, on many occasions we have developed an iterated visiting guidance, responding to requests from the sector for a steer on how to manage the challenge of wanting people in care homes to be visited while acknowledging the risks to residents of more people coming through the door. We have drawn a huge amount of clinical guidance from the deputy chief medical officer of Public Health England on how we can enable safe visiting. Clearly, we have substantial caution because we know the great risks to care home residents when covid gets in and how difficult it is to stop an outbreak from spreading through a care home, even with the PPE, the testing and the other things I have outlined. One reason why we introduced visitor testing was to reduce that risk.

Since 12 April, care homes have been able to open up to two visitors, and the essential care giver scheme addresses particular need. I look forward to care homes being able to continue to open up, step by step, through the combination of lower infection rates and vaccination, to enable people to once again spend much more time with their loved ones.

Several hon. Members spoke about visits out. I recognise the importance of both having visitors at care homes and being able to leave—to go out and about. This applies to older people, but particularly to families who have relatives of working age in residential settings, who I have spoken to. Often, somebody of working age might come out every weekend to spend time with their mum and dad, and their family. Clearly, they have not been able to do that during the pandemic.

I ask other hon. Members with an interest in this subject to listen to the Joint Committee on Human Rights sitting held yesterday, when I was asked about this. With me was Dr Éamonn O’Moore from Public Health England, who explained in some detail, which we do not have time for today, the reason for the caution around visiting out and the clinical reasons for the requirement to isolate for 14 days on return. To respond to the hon. Member for Worsley and Eccles South, I should say that that is not the same as somebody coming from overseas to the UK and quarantining, because of the particular circumstances within care homes. There may be people who are very vulnerable. In the event that someone brings covid into the care home, that can lead to an outbreak, which can lead, sadly, to people dying. Therefore, rightly, the issue is taken seriously.

I assure colleagues that, as Dr O’Moore said to the Health and Social Care Committee yesterday, I have asked Public Health England to provide advice on how to make more visits possible—particularly those with lower risk, such as those outdoors—and on what could be done to reduce quarantine requirements afterwards. I am mindful of the May elections and of those who might want to vote in person.

My right hon. Friend the Member for Ashford rightly said that vaccines are the answer to allowing more visiting and for much of life to come back to normal, for those who receive social care. We prioritised the social care sector for vaccinations—and particularly care homes, who were top of the list. The vaccine was offered to all care homes by the end of January, on time. Soon, all residents who can be vaccinated will have been offered their second dose.

The impact of vaccination is already being seen, with the rates of covid coming right down in care homes. There are still some outbreaks and I would caution those listening to the debate that the vaccine is not 100% effective. Many residents have had their second dose but others are still only on their first, and it is important in that situation that the precautions continue. For instance, we are continuing to urge care homes to make sure that staff use PPE and infection control measures, even when everyone has been vaccinated. However, there are far fewer outbreaks and the consequences are much less serious. I want to use this opportunity to thank the NHS vaccination teams, and the social care workforce, who have been involved in the tremendous and lifesaving effort to vaccinate so many thousands of people in social care.

Many hon. Members spoke about the importance of reform, and how the pandemic has shone a light on the social care sector and the need for reform. I truly welcome the support for reform among hon. Members who have taken part in the debate in this room and virtually. Some steps have begun, and I urge the hon. Member for Dulwich and West Norwood to look again at some of the social care content in the health and social care White Paper, including the voice of social care in integrated care systems—and I agree with the point made by my right hon. Friend the Member for Ashford that it is not just about a local authority voice, but the wider sector.

The White Paper also proposes the introduction of a new oversight and assurance system for social care, which I see as an important part of building on the experiences of the pandemic, to give us more oversight and the ability to drive quality and outcomes more strongly for those who receive social care. It also includes steps to support better use of data and data sharing for social care.

Those things are, however, just the beginning and we need to go further. We have committed to go further and to publishing a long-term plan for social care this year.

Photo of Barbara Keeley Barbara Keeley Labour, Worsley and Eccles South

As the Minister is talking about the White Paper, I wanted to point out that we have talked quite a lot about unpaid carers in the debate, but they are not mentioned once in the White Paper. Carers’ organisations took that in a bad way and felt that all the efforts that unpaid carers put in during the pandemic were not recognised at all. The Minister and the Health Secretary need to address that.

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care)

The hon. Member makes a really important point, and I really appreciate how she has spoken about unpaid carers during this debate. I absolutely recognise the crucial role of unpaid carers, the things that unpaid carers do and the demands on and challenges for unpaid carers during the pandemic. I absolutely see unpaid carers as part of the breadth of the social care system that we must consider for the reforms as we go forward.

I very much welcomed the expertise, in the room and virtually, on social care reform. My right hon. Friend the Member for Ashford reminded us that the reform debate has been going on for nearly 25 years. He has extremely valuable experience. My hon. Friend David Simmonds has great experience from local government and flagged the work of Sir Paul Carter, whom I know because he is the former leader of Kent County Council and I am a Kent MP. I will indeed be looking at the work that my hon. Friend mentioned. My hon. Friend David Warburton called for a social care workforce strategy. Yes, absolutely, as part of the reform work, we need and plan to bring forward a strategy for the social care workforce.

I am conscious of the time and so that is probably as far as I can go today, but broadly, I truly welcome the support for social care reform expressed during this debate. I assure those in the room and all those listening to the debate that we are determined to seize this moment. We have supported social care at an unprecedented level during the pandemic; on the back of that, we are determined to bring forward the reform that we know social care needs.

Photo of Helen Hayes Helen Hayes Labour, Dulwich and West Norwood 4:41 pm, 22nd April 2021

I thank all right hon. and hon. Members who have contributed to the debate today. It has been a reflective debate and one full of immense experience and knowledge of the social care sector, and that is very welcome.

In the couple of minutes that I have, I will push back slightly on some of the Minister’s comments. It was disappointing that she mentioned additional funding, PPE and testing and talked only about the things that the Government did later on in the pandemic—the very deep trauma experienced by the social care sector with regard to a shortage of PPE and lack of access to testing was in the early months. I feel that, by failing to mention it, she does a disservice to those workers and residents in the social care sector who really suffered the impact of the Government’s failure to plan ahead of time for a pandemic and their failure to deliver and get swiftly off the blocks when the pandemic hit.

The point that I would like to make about the health and social care White Paper is that it talks about integration, but without talking about social care reform, and that cannot happen. We have an NHS, which is a well organised national system, founded on a statutory basis; and we have social care, which is not a system but a fragmented and diverse set of organisations and individual families all struggling and all brought to breaking point by the lack of funding, the lack of organisation and the lack of overall structure and accountability.

If there is to be integration, it has to be integration on the basis of parity of esteem, and that involves the Government getting to grips with the question of reform. I urge the Minister just to take seriously the voice of the APPG and the sector, to continue to engage and, most importantly, to start a structured process for cross-party talks, so that together we can deliver the change that the social care sector so desperately needs.

Question put and agreed to.

Resolved,

That this House
has considered social care and the covid-19 outbreak.

Sitting adjourned.