Barbara Keeley MP speech at the Association of Directors of Adult Social Services Conference
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Thank you for inviting me to speak to you today.
Before becoming an MP, I spent nine years as a councillor in Trafford where I was vice-chair of Adult Social Services and Cabinet Member for Health and Wellbeing. I understand the pressure that councillors, lead members and Directors of Adult Social Services face.
People do not work in or serve as councillors in Social Services in order to make cuts and I understand how difficult making those cuts can be.
I am here today to talk about the next Labour Government’s approach to delivering a new system of social care.
We are working on this, but I can set out today:
- Some of the challenges facing the care sector and the urgency of the need for reform.
- The principles of our proposed National Care Service
- And some thoughts on new approaches to commissioning
I think we can all agree that reform is long overdue.
But nearly twenty years after the publication of the Royal Commission report on funding long-term care for older people, and 12 consultations and four independent reviews later, reform is still no closer.
This is despite the major challenges that we all know our care system faces, both now and in the future. We are now in the eighth year of government cuts to council budgets which have hollowed out our social care system. While demand has grown, supply of care has dropped.
Cuts have also led to falls in the quality of care, with one quarter of care facilities now getting the lowest ratings for safety from the Care Quality Commission. As new research from the charity Independent Age has shown, some councils may have to place people eligible for publicly-funded care in poorly-performing services because there are no alternatives. Meanwhile, the Alzheimer’s Society has reported that some families face the prospect of relatives with advanced dementia being evicted from residential care on the grounds of cost.
There is a serious short-term funding gap in social care that needs to be filled. The National Audit Office has warned that councils could face bankruptcy from meeting the costs of social care alone. Piecemeal funding, as the Government has repeatedly offered, is not the way to solve this crisis.
Social care remains at a ‘tipping point’ and the case for reform has become too critical to ignore.
I question why the Government is spending time on a further consultation and Green Paper, when so many ideas are already out there?
Rejecting those ideas has wasted public money. The Government spent £1 million on the Dilnot review, only to delay the introduction of its recommended care cap before later shelving it indefinitely.
As a result, tens of thousands of people who would have benefitted are now left struggling with care costs which can be at catastrophic levels. Worse still, many people are not aware that have to pay for care, leaving them unable to plan for paying these costs.
Labour recognises that we must first address the system’s pitfalls and the unfairness to which they lead.
Only then can we work to ensure that all people with care needs can be sure of a good standard of care in the future.
The Secretary of State for Health and Social Care finally broke his silence on social care, two months after it was added to his title. I noticed that the seven pillars he set out in his speech two weeks ago look similar to the six pillars of the National Care Service, set out in Labour’s 2010 White Paper. They say that imitation is the sincerest form of flattery.
But while the Secretary of State says the country needs to “do better” on social care he seems to forget that it has been the cuts to council budgets made by this Government which led to the current crisis in social care. And despite repeated pleas from councils and from ADASS, the Government has failed to give social care the funding needed to ease the crisis. I believe that the focus of the Government’s Green Paper is too narrow. The focus is on funding for the care of older people, with the needs of working age people relegated to a parallel work stream.
We need a care system that considers the needs of people of all ages. That is why Labour will include in our plans the growing numbers of working age people with care needs, on whom councils now spend an increasing part of their adult social care budgets.
Our plans for a National Care Service recognise that people in need of care, their families and those that deliver care want a care system that focuses on the individual. A care system that enables them to remain as independent as possible for as long as possible and that enables them to have a good quality of life. They want care that not only meets their practical needs, but their social and emotional needs too. And care that is delivered by well-trained care staff who have time to talk as well as time to deliver high quality care.
People in need of care want a social care system that minimises financial uncertainty and places them in control, allowing them to plan for the future. And above all, they want to be treated with dignity and respect. Enabling people to live independently also means preventing people’s care needs from increasing to higher levels.
That is why principles of prevention and early intervention will be important considerations in developing Labour’s National Care Service. We recognise that delivering a new system of care encompassing all these elements will be a complex process. So we will approach it in several stages.
We plan to begin reforming the system with measures to ease the current crisis and to start to restore stability.
At the 2017 election we pledged £8 billion extra for social care across this Parliament with an extra £1 billion to ease the crisis in social care this year.
This would be enough to offer a real living wage to care staff. And it would have been enough to start to offer more publicly-funded care packages, the numbers dependent on the level of needs being met. Our current pledged investment will begin to address the problems in our unstable care market.
It will begin to improve care quality and restore much-needed public confidence in the care system.
But maintaining the current funding system is not an option in the long term. Our current system of financial eligibility is hard to understand and difficult to navigate, to say nothing of its unfairness. Those with health care needs have their care paid for by the NHS, whereas those with conditions like dementia can end up paying catastrophic care costs. People are losing their homes to pay for care, despite the Government pledges to prevent that loss during their lifetime.
The public has started to notice this unfairness. Recent polling by the Alzheimer’s Society showed not only that that paying for social care is a growing concern.
There was also overwhelming public support for an upper limit on care costs. The Government regulated to set the cap brought in by the Care Act at £72,000 but this cap has now been abandoned.
Though Labour is in favour of implementing a cap, we recognise that the Government’s proposed level of cap would have only benefited 1 in 10 people who pay for their care costs. According to the charity Independent Age, under Government’s proposed cap under the Care Act, it would typically take a person over six years to reach that care cap.
It’s clear that we need a new commitment to cap care costs. A cap will introduce a way of sharing the risk of paying for care across the population.
Everyone will contribute, to avoid individuals facing catastrophic care costs.
So, as part of the second phase of our vision, the next Labour Government will implement a maximum limit on care costs at a lower level than set in the Care Act.
And we will also raise the asset threshold to a higher level than it is under the current system.
In last year’s General Election manifesto, we suggested three possible means of funding the National Care Service, which we believe will cost around £3 billion annually:
Either through wealth taxes, an employer care contribution or a social care levy or a combination of these.
We are currently taking soundings on the fairest way to fund this and we will be coming forward with proposals.
Of course, any discussion of fair funding of a new system has to look at the standard of care the system provides. That standard must command public confidence, so that those paying in can be sure that they will be getting good quality for their contribution. So our new system needs to drive quality as a matter of urgency.
Commissioners can play a crucial role in this through the packages of care they purchase for people with care needs. But the fragmented nature of our current care system has weakened the provider sector and hobbled commissioners from purchasing care which is truly focused on people’s needs. And councils’ capacity to commission and monitor services has been drastically reduced by years of cuts, undermining their ability to shape local care markets. In the current care landscape, commissioning cannot always achieve a wider purpose beyond finding whatever care is available, even if it is of poor quality.
Labour is looking at a different approach. We want to ensure that reform spurs greater innovation, as well as increasing the quality and sufficiency of care. So we will explore more ethical ways of commissioning to drive up quality and create a more vibrant provider sector.
Firstly, we recognise that good quality care rests on care staff who are properly paid, with the right values and with opportunities for training and development.
So we will explore ways to ensure that commissioners purchase care from providers with improved workforce terms and conditions as a minimum requirement.
And from providers who have effective training, development and supervision, as well as those who sign up to ethical care agreements.
We could also encourage commissioning from organisations with a social purpose, from within the voluntary sector, from social enterprises and from mutuals.
Large residential provider chains with big market share can exhibit unsustainable business models and have opaque tax structures. At times when they experience financial problems, they do not always offer consistently high quality care and they cause uncertainty for residents about the future of their homes. Their corporate structures reduce potential tax take as well as adding pressure to an already creaking care sector through the threat of provider failure. So we will explore how commissioners can encourage greater tax transparency from providers to improve accountability to residents and taxpayers alike.
Good quality care rests on long-term relationships. That is why these relationships will lie at the heart of our vision for a National Care Service. Evidence suggests that newer, innovative models of care which harness these long-term relationships, like Shared Lives and Home Share, provide outstanding care.
So we are keen to explore what role new models of care, and the settings that support them, can play in our National Care Service. We will be assessing their scalability. The care workforce is not keeping pace with increased demand, which is coming both from the growing numbers of older people and from working age populations with complex needs.
Care quality rests on staff having good pay and conditions, but much of the current care workforce is underpaid, undervalued and overworked. That is leading to high turnover and vacancy rates, both among care staff and the registered managers who are responsible for overseeing care quality. In certain care settings, high turnover often sees people with care needs spend time with multiple different staff – effectively being given “care by strangers”. That does not result in good care.
We see that social care needs to be valued as a career. That is why, at the last election, we pledged to implement the real living wage for all care staff.
And to ensure care staff were paid for travel time, that 15-minute care visits were scrapped and that zero hours contracts were ended for care staff.
But we need to go further. This will mean improving care staffing levels to reduce the workload pressure and offering better training and career paths.
We will look at how we can bring more professional standards to the care workforce. And we will explore with providers how they can play a bigger part in improving the skills of the workforce locally. Helping to make social care a more valued and desirable career.
We need to give some thought to how having insufficient care and having poor quality care heaps pressure on unpaid family carers, including the 2 million carers aged over 65. I recently attended an event in Parliament to mark the launch of Age UK’s report “Why call it care when nobody cares?”
The anger of the older carers who spoke at or attended this event was palpable and it was also reflected in the title of the report.
The carers told me how they and their families are often at breaking point. How they feel betrayed by a system of care that leaves them with little or no affordable support.
How they face rising care costs which they describe as “crippling” but that the care they pay for is too often not good enough. Labour recognises that unpaid family carers need more support.
We understand how much families are doing to look after family members and how hard this is for many carers. Yet, the Government hasn’t even developed an updated National Strategy for Carers, scrapping the planned Strategy last October. And since then even failing to publish a promised Action Plan.
We will develop an updated National Strategy for Carers. So that together we can establish what is reasonable for families to do and what help and support they can get.
I would like to set out some of our thinking on integration. Currently, the evidence shows that integration is not the cure-all for the problems in health and social care.
There is a danger that integration is being seen as a way of reducing NHS pressures rather than understanding that social care is an important service in its own right. Integration should be about enabling people to move between healthcare and social care settings seamlessly.
Encouraging every agency to collaborate for the benefit of the person receiving health and care. But it has to be approached in a way that protects local governance and democratic accountability. And that allows the system to see the individual, enabling them to regain independence. Not just as someone occupying a much-needed NHS bed.
We know that our proposals will not succeed unless people know what social care is, when they will need it and how it is paid for.
The funding of social care has for too long been an unknown in the eyes of public. Social care funding is complex and we know there are big gaps in public understanding about it.
The issues surface at election time, when political parties’ policies are subject to fierce criticism from commentators.
The reaction to the Conservatives’ new proposals for social care made during the General Election 2017 showed how little the public understands the nature of the current system.
And how much they may have to pay for care under that system currently. As an MP, I know that most people start to understand the care system and their entitlements only when they or a family member have an immediate need for care. So we need to tackle this issue of low public awareness.
Our National Care Service will seek to give people clear information and advice about care and support. And we believe that there also needs to be a wider public discussion about people’s social care needs alongside their healthcare needs.
We need to counter the idea that building a sustainable system of care in the long-term is unachievable. It’s time to have a more positive vision of how social care can enable people with care needs and how it can drive economic growth locally. Care should be part of the industrial strategy and I will work with my Shadow Ministerial colleagues on that in the coming weeks.
I hope that today I have helped to lay out Labour’s approach, which is the first stage on our journey towards creating a care system that enables people to live independently for as long as possible.
We will come forward with more detailed proposals in the summer.
And I look forward to delivering the next Labour Government’s vision for a new approach to care with individual wellbeing at its core.