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This debate is an opportunity to celebrate the many advances that have taken place in social care over the past 10 years and to set out the challenges that the sector faces in the next 10 and beyond. The background to the debate is the Commission for Social Care Inspection’s State of social care report published in January of this year. It reflects the diversity of social care, covering the public, private and voluntary sectors. I am sure colleagues in the House will make reference to this report and join me in saying how useful it is for the regulator of social care to have the duty to report to Parliament on the current state of social care. The three messages from its report are: that social care services continue to improve and modernise but improvement is gradual; that progress is being hampered by pressures on the sector; and that there are concerns about the impact of a shift of responsibilities onto individuals and families.



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There is much to welcome in social care today and there have been some significant advances in the past 10 years. The starting point is the central role of the people who use the services and their carers. It is about putting people first. Social care has led the way on the public policy debate around choice and personalisation. Direct payments and personalised budgets which are being piloted around the country are an example of this. The Government’s White Paper, Our Health, Our Care, Our Say, published in 2006, set the tone when it said:

In all the progress that has been made in putting users, carers and patients absolutely at the forefront, those who develop and provide social care have been pioneers, and we should congratulate them on that. We should not forget that, when we talk about putting users and carers first, we are talking not just about changing structures but about changing fundamental attitudes and cultures. We must acknowledge the progress that has been made in that area and recognise how difficult it is to change those attitudes and cultures. In spite of the progress made, we know that we need to go further and faster in ensuring that these aspirations are delivered on the ground.

While more people than ever who want direct payments are able to get them—the numbers doubled between 2004 and 2006—the commission’s recent report also found that only £1 out of every £100 spent in social care is a direct payment. If people want direct payments—and it seems that they do—we must make it easier for them to have access to them and ensure that they get them.

Another welcome initiative was the Government’s Dignity in Care campaign launched in November last year. The care services Minister in the Department of Health, Ivan Lewis, said:

Social care services are, on the whole, improving. The Government introduced national minimum standards for social care and a regulator, CSCI, to measure performance against those standards. The number of providers meeting the standards has increased, and that is a great credit to the sector. However, we should note that the rate of improvement has slowed down in recent months; the whole sector must double its efforts to show continued improvement. I am afraid that too many services are still not meeting the minimum standard, and that means that some people are receiving sub-standard care. I understand that the commission is modernising the way that it inspects services, which will mean fewer inspections for well performing providers and more attention spent on poor performers. Let us hope that the providers respond positively to these proposals and see them as a way of driving up their performance.



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At the end of April, the Department of Health published a review of the status of social care, Blueprint for Social Care Excellence. The review was carried out on behalf of the Government by Dame Denise Platt, who, as your Lordships know, is the chair of the commission, but the report was carried out in a personal capacity. When the Government published it, they announced a five-point plan to put excellence at the heart of social care. I very much welcome this report and the Government’s positive response to it. It is appropriate that the sector looks to itself to raise its game, and that will include a social care skills academy, which will look at skills across the public, private and voluntary sectors.

There are many skilled and committed staff in the social care professions but we have fallen short in our nurture of them: we must provide them with more opportunities for training and learning. I believe that these proposals provide the possibility for social care leaders to develop world-class skills. These leaders are providing a vital service and we must ensure that they are equipped with the skills to carry it out.

One important issue on which I want to focus today is one that CSCI and other notable bodies, such as the King’s Fund, have begun to talk about. I know that it is also an issue in which the Government are very interested. I refer to the major and unresolved debate about the balance between state and individual responsibility for funding social care, especially for old people but including other categories of people also needing social care.

Sir Derek Wanless’s review of social care funding on behalf of the King’s Fund concluded that the current system is unsustainable. The care services Minister has called for,

The review found evidence of significant unmet need in the current social care system. The report said that ultimately,

The Wanless review also said that there needed to be a commitment to reconfigure services, demonstrating value for money and fairness. The Government might consider that investing more in social care could realise benefits and savings in acute healthcare and reflect people’s choice to have care closer to home. I should very much welcome the Minister’s views on that.

The reality is that the state will probably not be able to pay for all social care but, if we make that decision and we make it openly—that is the key point—we need to ensure that we offer other means of support to people using care services, including those who can pay for their care themselves. I am aware that colleagues in the House have their own views about this and I look forward to hearing their contributions.



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The role of the informal carer—family member or friend—is an essential part of today’s debate and it figures large when we address the issue of where responsibility should lie. Your Lordships will not be surprised if I now turn to the role of carers.

There have been a number of major and very welcome developments for carers in social care over the past decade: three Acts of Parliament, including the groundbreaking Carers (Equal Opportunities) Act 2004, which recognised that carers have a life outside caring; the national strategy for carers, launched by the Prime Minister in 1999; and the carers grant, which provides funding for carers’ breaks. That grant has totalled £1.1 billion over nine years and has really made a difference through broadening out and developing a breaks service. However, a small-scale survey by Carers UK showed that these developments are now under threat by the shortfall of funding in social care generally and that several local authorities are now starting to cut back on carers’ break services in order to balance their budgets. That is not a trend that one would wish to encourage.

The main problem facing social care from the carer’s point of view is that funding has not kept pace with the needs within the community. As the Local Government Association and the Commission for Social Care Inspection reported, two-thirds of councils are cutting back on eligibility for services. Through Carers UK’s information and advice line, we know that that is starting to impact on carers, who will have to take on an even greater share of caring.

Some very welcome new developments for carers have been announced. The Government, through Gordon Brown, have pledged to review the national strategy for carers and ensure that it has a 10-year vision. He has also put some very welcome cash alongside that, including funding for an expert carers programme, a helpline and emergency care to cover the inevitable emergencies in a carer’s life. It is vital to take the opportunity now to achieve real change for carers.

The social contract that exists between the individual and the state must be clear. We need a new settlement where we have an honest debate about the relationship between private, public and the individual. The work carried out by the Disability Rights Commission revealed an enormous gap between people’s expectations of what they think they will receive and what they actually get. People still do not plan for the support that they might need if they become frail or disabled. In particular, they do not expect to become carers, when that is what almost every one of us will indeed become. There has to be long-term investment in social care, however it is funded. All the projections point to more funding being needed in the system. The Government need to link their care agenda with an employment agenda in the same way as they did with child care.

Leading employers are becoming increasingly concerned about how we deal with demographic change. Carers UK has estimated that by 2034 an additional 3.1 million people will be carers; in other words, a 50 per cent increase on the numbers today. In the next 10 to 15 years, the economy will need an extra

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2 million workers, only 500,000 of whom will be school leavers. Carers who are aged 54 and above are more likely to give up work in order to care, often at the peak of their careers, and one in four people currently between the ages of 45 and 55 are combining paid work with caring duties. The arithmetic of that does not stack up. We have to provide more support for carers and more support that will enable them to continue with their working life. There are many more arguments why we need to support carers better, but I shall conclude with one staggering one: that they save the nation £57 billion a year.

In conclusion, I repeat that there have recently been many significant and welcome developments in social care. In an age when older people are rightly demanding that their voice is not only heard but acted on, when people with disabilities are not prepared to be passive recipients of social care, and when more people are caring for their loved ones, it is correct that we have the opportunity to debate “What now?” and “Where next?”. I believe that the Government are on course. The personalisation and choice agendas are correct, but we need to go faster and further in ensuring that more people who are entitled to services know exactly what they are entitled to. We must discuss urgently the roles of the state, the family and the individual, so that the voices of the family and the individual can be added to the many others who want to express their views. I beg to move for Papers.

3.01 pm

Viscount Tenby: My Lords, the noble Baroness, Lady Pitkeathley, is to be warmly congratulated on initiating the debate today. She has introduced it so ably, with such knowledge and in such a measured way, at a time of justified anxiety, when the Local Government Association has estimated an overspend by local authorities to the tune of £1.7 billion, when MENCAP is reporting cuts from all over the country and when there are disturbing reports of young carers not receiving the support that they so desperately need.

I declare interests as chairman of the trustees of a non-profit-making residential home for women with learning and physical disabilities, in which my daughter is a resident, and as an honorary vice-president of MCCH Society Ltd, which provides social care for those with disability in Kent and other parts of the south-east. Consequently, I intend to speak only about provision for those with learning and physical disability.

Although I have been involved with men and women in this category for many years now, I am acutely aware that I am only an amateur. I take this opportunity to pay tribute to the many talented and dedicated people in social services and charities alike who have given, and are giving, their lives to make a better life for people. Nevertheless, it might be helpful to have the views of someone who is able to speak from a user’s point of view.

The flip thing to say—but perhaps no less true because it is flip—is that the three most crucial things in short supply over the whole area are common sense, cash and collaboration. In the Griffiths era, some 20 years ago—I am fully aware that the noble

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Baroness, Lady Pitkeathley, has a far greater background knowledge of this than I do—it was agreed on all sides to do away with large residential homes, many of which were survivors from the Victorian age. A combination of purpose-built homes, with five to 10 residents, for those needing 24-hour care and supported sheltered housing with assistance for those living in the community, was put in their place.

Clearly, many homes like the one with which I am associated, although very willing to adapt—I emphasise that—did not fit into that pattern, and the obstacles to overcome were, and are, very considerable. For example, pulling down a perfectly serviceable and comparatively modern building, which in our case can house 20 residents who have lived in amity for the best part of their adult lives, at a time when the financial cupboard has never been barer, must be a worrying leap into the unknown, to put it mildly. But to stay as we are is not an option. As we do not conform to the right size and, through a quirk of history, as the home is not multi-sex, we get no referrals to fill vacancies. Numbers and, therefore, income, drop with the financial consequence of closure. To whose benefit is that?

How different it is in the NHS. There, LBHUs—locally based hospital units, as they are called in some parts of the country—are relatively thick on the ground and come in all shapes and sizes. They are financed, not through social services, but via primary care trusts, for the most part. For example, according to the Sutton report, Orchard Hill Hospital has some 95 residents. Incidentally, anyone wanting to see how inadequate and unjoined-up our administration has been for those with learning and physical disabilities in recent years, under whatever Government have been in power, has only to read the contents. That hospital is now due to close in 2009. At least, it has now been inspected, although with dire consequences, by the Healthcare Commission.

That situation sits oddly alongside our own experience of frequent inspections, which we welcome as progress checks to better standards, and the covert message that we continue to receive of, “Put up or shut up”. The phrase “double standards” inevitably comes to mind in spades.

What about supported living within the community? First, one needs the accommodation, of course, which is no easy task, particularly in affluent areas such as the south-east. In some instances, one may have to overcome antagonism in the local community. It exists—do not let us try to hide it and sweep it under the carpet. That is not because people are intrinsically selfish, but they are very likely to be ignorant of something that they themselves have never experienced. All kinds of ancillary concerns can therefore emerge; for example, a drop in the value of their own properties, the effect that close proximity might have on their children and so on.

Common sense is important in a variety of ways. I remember many years ago the planned closure of a large and much-loved day centre, which took in users from a wide geographical area. That was in response to a perfectly logical shift to more local centres. In accordance with modern thinking, with which in principle I wholly agree, the users were told of the

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plans well in advance, when the final plan was, in fact, years away from coming to fruition on even the most optimistic estimate. The result was unnecessary fear, uncertainty and grief, not only among users, but also among their families. Surely we should consider the feelings of those who may already have had much to endure in life. I am afraid that occasionally professional workers, because of their expertise and experience, are confident that they know better than users’ families and voluntary workers. That leads me to ask the Minister to embrace and encourage the use of voluntary workers in this area and to facilitate the security clearance that we all know is necessary. If that takes too long and is too bureaucratic, it can turn helpers away.

Noble Lords may have noticed that I have not so far referred to finance. I shall merely say to the Minister that it seems to me that social services are the poor relations of the NHS, which is inevitable, when there is so much pressure on council spending. The black hole of over £1 billion, referred to earlier, hardly gives one confidence in the successful financing of grandiose new projects. As so often in government finance, execution follows a long way behind aspirations, yet the need is massive. If one accepts that one in 10 families in the UK has relatives with some sort of learning or physical disability, that points on a conservative estimate to a market of about 4 million or 5 million people. The first step might be the disentangling of NHS and social services finances, as has already been hinted at. Indeed, that has begun in some places, with mental health provision staying with the NHS and learning disability provision going to social services.

That leaves me with one remaining heading: co-operation. A top priority must be the ending of any dysfunction within the provider network, so that a seamless service is available. A recent report by the Picker Institute has highlighted the lack of across-the-board access to information for service users on matters such as the financial benefits available and how to claim them.

Finally—and I commend this to the Minister most strongly—let us embrace wholeheartedly the concept of partnership, be it in the NHS or social services, or within various voluntary organisations. In particular, learning disability partnership boards should be engaged in decision-making, but so often they are bypassed. Let there be no petty kingdoms, of which one hears examples from time to time, but a common resolve to solve problems and create initiatives—in the use, for example, of available land and joint building projects, such as the MCCH project in conjunction with Kent Community Housing Trust, where a 22-bed facility for people with dementia sits alongside a home for 120 elderly people. There is also the home in Hampshire with which I am associated, which, in conjunction with a sympathetic and listening council, is seeking ways in which partnership can become a reality.

The National Health Service is, understandably, seldom out of the headlines. Just for one afternoon, however, can I make a plea that it stands to one side so that its poorer cousin can get a fair hearing? The

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future reputation of this country depends equally on the sympathetic and imaginative treatment of those not fully able to look after themselves, whose lives can yet be considerably enriched by a sensible, sensitive and well resourced social service.

Baroness Royall of Blaisdon: Forgive me, my Lords, but may I remind the House that time is extremely tight for this debate? I therefore ask noble Lords to keep strictly within their eight minutes. Thank you.

3.10 pm

Baroness Howarth of Breckland: My Lords, I, too, congratulate the noble Baroness, Lady Pitkeathley, on leading this debate and I pay tribute to her long and dedicated career in social care. As her deputy chair in the Children and Family Court Advisory and Support Service, I know at first hand of her tireless commitment, particularly to carers and children.

I also pay tribute to the work of the Commission for Social Care Inspection and the role that its board and staff have played in raising standards in social care. As deputy chair of its predecessor, the National Care Standards Commission, I know personally how much had to be done. The average percentage of national minimum standards met in services inspected by the commission had, by 2005-06, risen for the fourth consecutive year and more councils improved their star ratings. Progress has slowed, but we all know that the better it gets, the more difficult it becomes. In addition, performance against national minimum standards is getting better. For example, the overall figure of care homes meeting standards has risen from 58 per cent in 2003 to 79 per cent now. We should not lose sight of these very real achievements, both by those who set the standards and those who work so hard to meet them—the local authorities and the independent and voluntary sectors.

Against that positive background, I want to raise some key issues with the Minister about care services. In an era when we hear much about choice, the report tells us:

For two-thirds of councils, the threshold for care-managed services was set at “substantial” in 2005-06 and a number of councils were expecting to raise their eligibility thresholds in 2006-07. It may be that service is getting better if you can get it, but what are we doing to ensure greater accessibility for all? The options for people who do not meet the criteria set by local councils are limited. As the report says,

It actually means less choice.

As this rationing process develops, more people will look to fund their own care where they can. Who will ensure their rights to quality and value for money? People expect the state to give them financial as well as physical protection as they grow old, or if they are vulnerable. The noble Baroness, Lady Pitkeathley, talked about the state. For the ordinary person, the provider of the service, whoever they are, represents the state. People expect the services to be civilised—the kind that a really civilised society would provide—but, as

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has been said, they remain concerned about the gap between policy aims enunciated by the Government and the reality of their experience.


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