Lords briefing: Social care debate

ePolitix.com reports on Thursday's House of Lords debate on the care of older adults and long term disabled people.

The substantial division between healthcare and social care was the main focus of a Lords debate on the care of older adults and long-term disabled people.

Introducing the debate, Baroness Fookes (Lab) expressed her concern that without a cure, the number of people living with dementia is expected to increase to one million in the next twenty years.

She highlighted the significant fault line between health and social care. Whilst healthcare is free at the point of delivery, social care is means-tested, and Fookes argued that people find the systems complex, unfair and confusing to navigate. She said that this is intensified for people suffering from dementia or Alzheimer’s disease who have to pay to enter care homes.

In addition, Baroness Fookes said that the eligibility criteria for social care vary between local authorities. She feared "rationing by the back door", as local authority budgets are squeezed during the economic downturn.

Fookes condemned the lack of progress on elderly care, and called for a system of limited liability, under which a person is means-tested for two to three years. After this, the state would pay for social care, she suggested. Fookes also supported direct payments to empower people, with the provision of administrative support.

Praising the work of carers, Baroness Fookes called for universal respite care to provide support in unexpected circumstances. She emphasised the importance of improving quality of life and called for more imaginative solutions.

In a pragmatic response, Lord Lipsey (Lab) said that the chance of further substantial funding for social care is not high. He said that there is a limit to the amount of money that the government and society will be willing to devote to elderly care.

Instead, he argued that the potential contribution of the private sector should be examined. Equity release could ensure access to assets if people are forced to enter care homes, Lord Lipsey said.

Stressing the importance of financial advice for older people, Lord Lipsey expressed his concern that public provision for social care will become merely a safety net, not a duty.

Acknowledging the trying economic climate, Baroness Thomas of Winchester (Lib Dem) highlighted that the number of long term disabled people is likely to rise. As part of the personalisation of care, she argued that the carer’s allowance should continue to be paid to those over 65 who receive the state pension.

Baroness Emerton (CB) expressed concern at the current balance between effective leadership and appropriate accountability, and warned against overlooking signs of poor quality care.

Baroness Greengross (CB) highlighted the issue of age discrimination in social care, and called for the creation of a one-stop-shop to offer free advice on the different payment and care sources. She added that human rights must be at the heart of commissioning and legislation.

Urging a clear timetable for reform, Baroness Greengross called for greater preventative care and investment in dementia research.

Describing dementia as a "living bereavement", Baroness Gardner of Parkes (Con) called for free prescriptions for the long-term disabled. She emphasised the significance of concessionary bus passes, which help to keep people fit and interested in life. She suggested that similar initiatives could help reduce the growing demand for care.

Lord Rix (CB) questioned the lack of a statutory duty on local authorities to provide 24-hour care for disabled people, and said that the Department of Health must assume a stronger role in overseeing the transfer of care from NHS hospitals to the community.

Despite the commitment to equal citizenship for disabled people by 2025, he argued that local authorities do not have the budget to meet the demand for services.

Baroness Morris of Yardley (Lab) raised her concern that "too many older people feel that life has nothing left to offer them", and feel excluded from activities.

She asked whether the government’s policy of life-long learning includes the elderly and frail.

Viscount Tenby (CB) commended the work of the Commission for Social Care Inspection (CSCI) and welcomed the new strategy, Valuing People Now, for its ambitious plans to ensure the quality of life for those with learning disabilities.

However, he highlighted the current gap between demand and what is available.

Adding his voice to the calls for the green paper on adult social care, Lord Sutherland of Houndwood (CB) observed that the most successful local authorities are those that have co-ordinated health and social care.

Lord Kirkwood of Kirkhope (Lib Dem) argued that taxation alone will not be enough to prevent resource shortages in social care. He said that families and individuals must make additional contributions.

Earl Howe, Opposition spokesman for health, said that changing demographics and societal expectations will require a new settlement between individuals, families and government.

He said that the imminent green paper must find a solution, or admit for now that the challenges are too great for the NHS to tackle. He called for an end to local authorities making decisions on eligibility.

He argued that society has a contradictory attitude towards carers, heaping praise on them whilst underpaying or completely ignoring their needs.

In her response, Baroness Thornton (Lab, Government Whip) pointed out that older people are now healthier and more active than before, and life expectancy has improved.

However, she acknowledged that retaining independence often relies upon access to quality health and social care services. She said that the green paper will be published later in the spring, and will look at the possibility of reforming the social care system for all adults.

Describing the carers’ strategy as a "spotlight on the unsung heroes in society", Baroness Thornton highlighted the government’s aims of increased choice and control for carers.