Shadow minister Liz Kendall has used a speech today to set out Labour’s priorities for social care – improving access, establishing the principle of ‘home first’, delivering for disabled people and supporting unpaid family carers.
The key objectives outlined by the Labour frontbencher were presented as “tests” that would see the government’s white paper on social care – expected to be released imminently – “deliver real and lasting change”.
“We have got to stop doing things ‘to’ or ‘for’ people, and start doing things with people,” Kendall told the National Children and Adult Services Conference. She said service users should be “equal partners” in determining support.
Below is the full text of the speech by Liz Kendall, Labour’s shadow social care minister, to the National Children and Adult Services Conference today.
I want to start by thanking all of you and all of your teams for everything you’ve done over the last 18 months during this awful, awful pandemic. I know from my director Martin Samuels and my local lead for social care Cllr Sarah Russell the pressures you’ve been under week in, week out relentlessly, and my constituents would not have got through this without everything you’ve done – so thank you.
I think that transforming social care is the challenge of our generation. And this was true way before the pandemic struck, but that Covid-19 has exposed more than ever the urgent need for reform. So far, the government has fallen woefully short of the mark.
Their National Insurance tax rise won’t “fix the crisis in social care”, let alone build a system fit for the 21st century. The so-called ‘NHS and Care levy’ won’t provide any additional resources for social care until at least 2023, with little if any guarantee of extra funding after that.
As ADASS have said, it won’t provide a single extra minute of care and support or a better quality of life for older and disabled people. It won’t tackle endemic staff shortages and low pay or do anything to help millions of unpaid family carers who’ve just been pushed to breaking point trying to look after the people they love.
And I’m afraid that the government’s cap on care costs won’t stop people from having to sell their homes to pay for care either, despite repeated promises from the Prime Minister.
This week, the Conservatives voted through changes to the cap that mean those with low and modest assets won’t be protected from having to sell their homes, but those with houses worth £1m will end up with 90% of their assets protected.
So millions of working people will have to pay more tax – not to improve care services, or to protect their own or their parents’ homes, but only to protect the homes of the wealthiest. It’s unfair, it’s wrong, and the government must think again.
Ministers should go back to the drawing board, starting with the white paper on social care, which we hear is ‘imminent’. This should be a ten-year plan of investment and reform, which deals with the immediate challenges as we emerge from the pandemic and head into a difficult winter, and puts in place the longer-term reforms our country desperately needs for the future.
Because whilst extra resources are essential, simply putting more money into a broken system won’t deliver better results for care users, or better value for taxpayers’ money.
Today, I want to set out the tests the white paper must meet if the government’s going to deliver real and lasting change.
The first test is improving access to social care. After a decade of cuts to local authority budgets, 300,000 people who have been assessed as needing care are now stuck on council waiting lists. Even more need help with the basics of daily living but are going without: around 1.5 million older people, according to Age UK.
Ensuring all older and disabled people get the right support when and where they need it is essential to improving their quality of life, and it’s crucial to delivering better value for money too, so people don’t end up having to use more expensive hospital or residential care before their time.
Increasing access to care must be part of a much more fundamental shift in the focus of support towards prevention and early intervention.
We will always need residential and nursing homes, and there are huge challenges to address, including the modernisation of facilities, but most people want to stay in their own home for as long as possible.
The government should enshrine the principle of ‘home first’, to help people live as independently as possible for as long as possible.
That means bringing together all the different staff into one team – care workers, district nurses, physiotherapists and occupational therapists – to focus on keeping people at home and so families don’t have to battle their way around the system.
It means ensuring people have the home adaptations they need, with new monitoring technologies – which can make a huge difference in supporting independent living – alongside early help from local community groups with things like shopping, cleaning and visits to tackle loneliness.
I think the government should also expand the range of housing options between care at home and a care home, like extra care housing and retirement villages, which are much more common in other countries.
The third test for the white paper is delivering for disabled people.
A third of the users and half of the budget for social care is for working age adults with disabilities and yet their needs have been almost entirely excluded from recent debates about social care reform, particularly the cap on care costs.
The needs and concerns of disabled people must be at the heart of the white paper: based on the principle of independent living and underpinned by greater choice and control, including through expanding the use of Direct Payments and Personal Budgets.
The government must also end – once and for all – the scandal of people with physical and learning disabilities being kept in long stay institutions. Ministers promised to do this over a decade ago but have repeatedly failed to deliver. This scandal is one of the worst public policy failures I’ve seen in my 20 years working in this sector.
Today is Carers’ Rights Day, so the fourth test for the white paper is transforming support for England’s 11 million unpaid family carers.
Before Covid struck, almost half hadn’t had a single break for 5 years. Since the pandemic, 80% of family carers say they’re doing even more. 1 in 3 now have to give up work or reduce their hours because they can’t get the help they need to look after the person the love. This makes no absolutely no sense for them or our economy.
So the white paper must set out how the government will ensure councils can deliver the rights of unpaid carers which have already been set out in the Care Act; provide families with proper information, advice and breaks; and how they’re actually going to change the world of work, and improve flexible working so unpaid carers can better balance their work and family lives as we all live, and work, and care for longer.
None of these improvements will be possible without radical improvements in the workforce. I don’t need to tell you that across the country staff, shortages are the most pressing issue the sector faces. There are currently over 100,000 vacancies in social care and we need half a million additional care workers by 2030 just to meet demographic demand.
Labour is calling for a New Deal for Care Workers, to transform their pay, training, terms and conditions, ensure proper career progression and so frontline care staff are equally valued with those in the NHS. We will never improve the quality of care unless this happens.
But there’s something even more fundamental that needs to change if we’re going to deliver lasting reform.
Every time I speak to people who actually use care and support, I am struck by the yawning chasm between what they want for their own lives and what ‘the system’ – and let’s be honest, wider political debate – actually offers.
Social care isn’t only about helping older and disabled people get up, washed dressed and fed, vital though that is.
At its best, social care is about something both more simple and more profound: ensuring every older and disabled person can live the life they choose, in the place they call home, with the people they love, doing the things that matter to them most. In other words, an equal life to everybody else.
The brilliant group Social Care Future has pioneered this vision. Making it a reality means ensuring the people who use services, and their families, are equal partners in determining services and support. You simply cannot get social care right or deliver high-quality personalised care unless this happens.
Take an older person with dementia. If you don’t work with their family to understand what their food they like, or the songs they like listening to, or the films they like watching, then you won’t be able to provide them with the best quality care and support.
Or the disabled woman in her 30s who told her council she needed a couple of extra hours support to go and see her friends, but was instead referred to the locally commissioned ‘befriending service’ of people she had never met. No wonder she turned them down!
We have got to stop doing things ‘to’ or ‘for’ people, and start doing things with people. That includes ensuring care users shape how staff are trained, how services are locally commissioned and nationally regulated, and how support is delivered on the ground.
Quite frankly, unless the white paper is absolutely explicit about this, and how it will be achieved, I fear it will end up gathering dust alongside the many other white and green papers we have seen before.
In conclusion, when the welfare state was created, average life expectancy was 63. Now it is 80 and one in four babies born today are set to live to 100.
Social care was left out of the initial post-war settlement but is now essential to ensuring older and disabled people can live the life they choose. It is essential to helping families stay in work as we all live and care for longer, and it is crucial to an effectively functioning NHS too.
In the century of ageing, social care must be at the heart of a modernised welfare state. It is as much as part of our infrastructure as the roads and railways, but it urgently needs investment and reform.
That is the scale of ambition we need from this white paper. It is time the government delivered.