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Debate on the Address

My Lords, I have worked in the fields of health and social care all my professional life and to declare all my interests would take more time than could reasonably be permitted. I will declare just two. I am chair of CAFCASS—the Children and Family Court Advisory and Support Service—which deals with children and families when they are at their most vulnerable, and I am vice-president of Carers UK, which supports and campaigns for that other most vulnerable group, the 6 million people who provide the majority of health and social care to their families and friends. The first thing I want to do, as well as congratulating my noble friend on his opening speech, is to celebrate the title of this debate—that the words ““social affairs”” are included in it at all. It is perhaps a sign that social care, for so long the poor relation in care matters and always swamped and often overlooked by what are often seen as more glamorous or dramatic issues about saving life or life crises, is recognised at last—or at least becoming more recognised. Social care is much more often about things that are singularly undramatic and most certainly not glamorous. I am delighted with the progress that we have made towards more recognition of social care, social work and, indeed, social workers under this Government. We have a Minister for Social Care for the first time and we have a General Social Care Council, of which I had the honour to be the first chair, and which has done so much to raise the status and quality of the dedicated professionals who work in this field. It is a field, let us never forget, which has great difficulty in recruiting staff, not only because of inadequate levels of reward, but because of the extraordinarily stressful nature of working with clients, families and individuals who are most needy and often most hard to help. It is remarkable how easy it is, even for those of us who have spent our lives on the front line, to forget how difficult social work is. In this regard, the Commission for Social Care Inspection has been of the utmost importance in championing social care, highlighting successes and failings and providing a strategic lead for the whole sector. The Health and Social Care Bill announced in the gracious Speech will contain provisions to create what I understand will be called the Care Quality Commission—to replace the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission. It will require all providers of health and social care to be registered and a consistent approach to regulation and inspection will no doubt bring benefits to patients and to service users. But we must ensure that the expertise built up by CSCI and shown to such advantage in reports such as The State of Social Care in England, published in January this year, is not lost. In addition, CSCI has a fine record in making the views of users and carers not just known but central to its functioning. We must ensure that this continues with the new body. It will have a smaller budget, but this is one area where we must not cut corners. We must remain concerned that the institutional attention of the new body does not become entirely focused on healthcare at the expense of social care and that resources are balanced accordingly. For example, there are concerns regarding the fresh duties for the Care Quality Commission, such as the current focus on the cleanliness of hospitals—as a survivor of a severe case of MRSA, I am all in favour of cleanliness in hospitals. But we must ensure that that does not cause already tight resources to move from social care to health. I hope that the Minister can provide some assurance on that in his reply. One of CSCI's key functions is that of providing impartial and objective information to potential users of social care services and their families, not least because one third of such people already fund their own care. This role must be continued and, ideally, expanded. It must link effectively with the national helpline for carers that the Government are setting up to provide consistent information to families in need of care services. The CQC must support social care services in focusing more on supporting carers in employment. Currently, the 4 million working-age carers are being failed by the system. Evidence from Carers UK's recent employment carers and services research carried out by the University of Leeds shows that more than 40 per cent of those caring full time and not in work say they cannot return to employment because of the lack of services available to support them. Current systems do not support carers at key stages of their lives. They must have reasonable expectations to a life beyond their caring role, as enshrined in the very welcome Carers (Equal Opportunities) Act 2004, but we must help them to fulfil those expectations. I wish to mention another Bill that is not strictly the subject of this debate, but carers will very much welcome in the Pensions Bill the creation of a new scheme of low-cost personal accounts that will give them some advantage. We need to make sure that personal accounts are sufficiently flexible for those moving in and out of work, as carers often do. There is also a continued need for a stronger focus on carers within the NHS. The NHS will benefit from a 4 per cent increase in its funding, as announced in the CSR. A great many of the reforms are predicated on the basis of people caring for people at home. Yet carers are often ignored and invisible to the NHS. It is vital that we ensure that carers are a priority for spending from the NHS budget, as well as local authority budgets, and that they are treated as partners in care. In this context, I want to mention the National Voices initiative—a new collaboration of which I am chair, succeeding the noble Baroness, Lady Morgan of Drefelin—which aims to bring the views of patients, carers and service users directly into the heart of health and social services, attempting to bridge the gap between the rhetoric and reality of user-led policy making. We have been delighted with the support given for this initiative by Department of Health Ministers and have every confidence that National Voices will soon be established as a true partner in the development of policy. Other key issues are to be welcomed in the Government's plans—in particular the Green Paper that we are promised on the future of social care funding, which signals a major reform of the current system. The CSR statement made it clear that the Government believe that there are real opportunities for reform within a system that shares the cost between the individual and the state and that provides both universal and progressive elements. A sustainable funding settlement is essential because, while the announced increase in social care spending will help carers and the people for whom they care, it will not, as we have already heard, meet the level of unmet need that currently exists, leaving many families to struggle on as before. I understand that my honourable friend in another place is beginning the consultation on the Green Paper immediately. When it is published we hope that at its heart there is a recognition that most care is provided by families and that the formal care system needs to fit around that, rather than the other way around. Of course, the review of the National Carers Strategy is also very welcome. I sincerely welcome the Prime Minister's interest in carers and greater awareness that carers are providing care at a cost to their own health, wealth and employment prospects. We need better recognition of the crucial role that carers play in society, reflecting that the care provided by families massively—I emphasise ““massively””—outstrips that provided by formal services. We must also welcome the Standing Commission on Carers, which has been established. It is important that it is given suitable resources and a strong remit to advise across Government. The New Deal for Carers, as the revised National Carers Strategy will be known, will be a 10 to 15-year vision. In order to implement and monitor the strategy effectively, it is essential that we have the required statistics. In that regard it is absolutely essential that the carers' questions are retained in the 2011 census. That is an issue on which the All-Party Group on Carers has been active and we must continue to pursue it with the Department of Health, the Treasury and the Office for National Statistics. In fact, all government departments should have an interest in retaining this question if they are to deal accurately with the impact of demographic change. I very much hope that the Minister will be able to give some reassurance on that. I said at the beginning that I was glad to see health and social affairs included in the title of our debate today, but I want to conclude by saying how glad I am that education is also included and that the noble Lord, Lord Adonis, is to reply to the debate. CAFCASS is sponsored by the Department for Children, Schools and Families, although it works in close co-operation with the Ministry of Justice because of its work in the court system. However, the fact that our sponsoring department is the DCSF is recognition that the work of CAFCASS is essentially part of the Every Child Matters agenda, and that safeguarding and caring for children at whatever stage of their lives encompasses public and private law issues, education and the provision of social care. We should never forget that, for the client, the user and the carer, which agency provides that care is of little interest and almost of no consequence. What is important is the quality of care and the quality of the intervention. To that end statutory agencies, voluntary sector providers and private sector providers must be prepared to work in the closest possible co-operation and partnership, keeping the focus always on the most vulnerable members of society who use the services. Government departments must similarly work in partnership and listen always to the voice of their users. Any legislation and especially some of the legislation we shall be considering in the next few months must keep that at its forefront. Safety and quality is everyone's business and that includes the users and carers.