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I shall turn to a few of my concerns about the White Paper. It refers to managing caseloads and workload management. It seems to imply that by reorganising and rebalancing the work within the authority, local authorities will manage to give manageable caseloads to those working at the front line. That is not my understanding. I spoke to a deputy director of children’s services who said that her local authority can afford a maximum caseload of only 14 for child and family social workers. Kensington and Chelsea can afford a maximum

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caseload of six. Do the Government recognise the need to better resource the most hard-pressed local authorities?

With more young graduates coming into social work, it is vital that they have the support they require. The paper moots a new status of newly qualified social worker, which would mean reduced caseloads and increased supervision for those entering. Ian Johnston, the director of the British Association of Social Workers, says that it would be criminal not to introduce such an arrangement. I say with regret that I too think it would be a betrayal of the incomers if the Government did not move as fast as they could to introduce this new status and to give them the support they need. Failure to do so would be bad for social workers and bad for users. If newly qualified workers made a mistake because of lack of support, it would set us all back again.

Finally, if there is another tragedy—and I am afraid that there may be because of the current state of affairs—I hope that the Government will not make a revolution but redouble their efforts to see through the important strategy they have introduced. I beg to move for Papers.

11.54 am

Baroness Pitkeathley: My Lords, I thank the noble Earl for securing this timely debate and look forward very much to hearing contributions from the knowledgeable and committed colleagues who have elected to speak. I must declare three major interests: I am a social worker and proud to call myself so—and in my time I have carried a caseload of 120; I was the first chair of the General Social Care Council and chaired the advisory group that led to its establishment; and I am the chair of CAFCASS, the biggest single employer of social workers in the country. Today, I particularly want to relate the experience of the CAFCASS workforce to the major challenges that we find in the social care workforce as a whole.

First, I want to acknowledge, as the noble Earl has done, what progress has been made in social care. The setting-up of the General Social Care Council, after 20 and more years of waiting, was a wonderful step forward. The council has further increased the professionalism of the social care workforce and the quality of social care services, keeping service users at their heart. It has also ensured public accountability for high standards of professional practice by a trained and trusted workforce. It has done a marvellous job in registering social workers and is anxious to go on now to register the rest of the social care workforce. I know that resources for this are not yet available and are being considered as part of the Comprehensive Spending Review. I seek an assurance from the Minister that the Government are considering this need urgently.

The Commission for Social Care Inspection, the Every Child Matters agenda and the legislation connected with it, and the whole drive to reform public services have brought about a change in the view and status of social care which, frankly, when I was a young social worker or even 10 years ago, could

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never have been envisaged. Of course, there is a long way to go still, and we shall be focusing in this debate on some of the changes necessary, but let no one doubt that the recognition of the importance of social care, the ambitions for it and its significance in the policy agenda have never been higher. For this, we should be grateful to the Government and even more grateful to the many thousands of people who work in social care for their commitment and dedication to jobs which are difficult and demanding and for which rewards, both financial and emotional, are in short supply.

CAFCASS is, as I said, the biggest single employer of social workers in the country and carries out a complex function that requires experience, knowledge and good practice informed by evidence. Our vision is to deliver a world-class service to children and families in the court setting; that means our staff must be able to receive good-quality training, to access information and knowledge easily and each to have an individual programme of development to help them work to the highest possible standards. All staff in the social care workforce require that support, not just front-line staff.

For CAFCASS, that means our business support staff must similarly be able to support the functions of the organisation effectively and efficiently. I submit that this applies across the social care workforce and that it is essential to ensure all staff are trained and supported; otherwise, our users are not assured of high-quality services at all times. We have to remember that those we engage with are probably contacting us at the most difficult times in their lives, and therefore all staff must deliver to high standards. This places heavy responsibilities on those who manage and—although I know this is not always a popular thing to say—we should value good management skills as highly as we value the skills of engaging with our customers. Good, supportive management is what enables our workers to be effective, as well as to withstand the huge emotional pressures to which they are subject.

However, managers always have to help social care workers grapple with the endless problem of insufficient resources. This is not an arena in which to call for extra resources for CAFCASS—my colleagues and I do that all the time elsewhere—although if the Minister would like to promise me some, I will gladly accept them. The instinct of most social care workers is to provide the best possible service to every individual client, yet knowing always of the numbers of other clients waiting for a service that, by necessity, has to be rationed in some way. This is not a new dilemma for the social care workforce, but we must always be mindful of the extra pressure that the necessity of balancing budgets puts on that workforce and the role of the manager in trying to cope with the inevitable dilemmas that it poses.

A further problem faced by CAFCASS, and reflected elsewhere, is the make-up of the workforce itself. For us, the issue is of an ageing workforce; 60 per cent of our employees are over 50, and replenishing staff at the point of retirement is

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therefore a key concern. For some employers, the major issue is not about an older workforce but about one that lacks experience, or is largely recruited from other countries, or which is not sufficiently diverse. The dilemmas faced are different but no less serious and, of course, we all compete for good staff. We fish in the same pool, so to speak. This problem used to be largely confined to London and the south, but it is spreading. The high turnover in local authorities impacts on our work, competing as we are with them for staff, and our workers often find themselves doing work that should have been carried out by the local authority but has not been completed.

I know that the initiative chaired by my noble friend Lady Morris with the Children’s Workforce Development Council is looking at some of the issues and I stress the urgency of doing so. I would also like to hear from the Minister what plans are being made for the future work and status of the CWDC. It is, of course, concentrating on early years work but there will be major lessons learnt for the whole social care workforce. While government recruitment campaigns for teachers and nurses have been successful, I understand that similar success has not been delivered for social care. Perhaps the Minister will update the House about what plans the Government have to remedy this and whether they plan a national review of social work salaries.

I want to say a quick work about training and development. When financial times are hard, this is always the budget that takes the hit, and CAFCASS is no exception. Standstill budgets have not enabled us to expand our training and development as we would have wished, although I heartily commend my colleagues for the progress they have made with the development of a knowledge, learning and development strategy and the rollout of a post-qualification framework. As we cannot go on putting more and more pressures on workers without paying and supporting them properly, so we cannot go on expecting them to deal with more and more complex cases without adequate training and opportunities for obtaining further qualification. I hope the Minister will be able to assure us that the Government will address this issue. We would not countenance a worker in the NHS administering a procedure to a patient in which they had no adequate training, yet in social care we enable sometimes inadequately trained workers to operate above their competence level in situations which are no less life threatening to the client.

12.02 pm

Baroness Shephard of Northwold: My Lords, I congratulate the noble Earl, Lord Listowel, on introducing the debate. As always, he has displayed his great commitment to the cause of young people and children, as has the noble Baroness, Lady Pitkeathley, from whose broad experience of these issues the whole House has benefited. I intend to concentrate on services for the elderly.

The purpose of the noble Earl’s debate is to question whether appropriate priority is given to investment in the social care workforce—in other words, is the cash

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allocated enough to meet the Government’s desired outcomes? Like the noble Earl and the noble Baroness, I pay tribute to the Government’s efforts in defining their desired outcomes. Both the noble Earl and the noble Baroness have mentioned Options for Excellence. There is also its companion document on implementation, Our Health, Our Care, Our Say, and the recent Green Paper on transforming the care system for looked after children, Care Matters. To these we should add the very considerable body of change and work engendered by Every Child Matters and what followed. So there has been no shortage of policy initiatives and frameworks, which are obviously important.

Nor, though, is there a shortage of urgency in the need for action. The Local Government Association paper, Without a care?, published last December, with which the Minister will certainly be familiar, makes clear the concern of local authorities—that is, those that have to deliver the services—about these issues. The paper points to the rising number of people aged 65 and over and aged 85 and over that we can expect in the next decade. It states that it is not simply the increasing number of people that pose a significant challenge but the increasing number of people with complex needs, with rising levels of learning and physical disability and dementia in the older population. These demographic points obviously cannot be denied, hence the timeliness of today’s debate. But the Local Government Association’s paper also points out a disparity between the increase in the government grant for social care services—14 per cent since 1997-98—and spending, which has increased by 65 per cent. So the question is: who is taking the strain?

I declare an interest in that I am patron of two carers’ organisations in the county of Norfolk. In the past I have been a chairman of social services and also the chairman of two health authorities. So I have been in and around the interface of health and social services for a very long time. I absolutely accept the difficulty of the dilemmas, which remain the same, but I also accept—I hope the Minister does too—the significant increase in the challenges.

A very apposite assessment of how matters stand in social care has been given by the chairman of the Commission for Social Care Inspection, Dame Denise Platt. The Minister will be very aware of the contents of her second report, which I believe was published last week. The report paints what I can only describe as a discouraging picture of how present government policy is affecting individuals and their families, and more worryingly, of how the situation is likely to worsen in the future. The position, put simply, is that more and more old and disabled people are relying on care from family and friends. To answer the question I posed earlier about who is taking the strain, in many cases it is carers. Without the support of carers and without finance, such individuals have to carry on until crisis point, when the local council steps in and does what it can. As Dame Denise has said, there needs to be a real debate about how people can prepare for that kind of crisis in their lives, which they may well experience. She added,

I stress that I feel that the Government’s intentions are admirable. The White Paper, Our Health, Our Care, Our Say, sets out the Government’s vision for high-quality support. One point made is that there needs to be a fundamental change in the provision of services and the workforce that delivers them to ensure that the vision can become a reality in the future. It suggests that that change is better integration of those working in the NHS and those working in social care. I would not mind a pound for the number of times I have heard that, not least when I was trying to achieve change in those very areas. It is extraordinarily difficult. I have had long and sometimes bitter experience of its difficulty, involving, as it does, the marriage of organisations with different management structures and different accountabilities.

I make a slightly critical point to the Minister. Is such integration being made easier or more difficult at ground level for those in receipt of social care and those trying to organise its provision by the programme of closures and cuts presently affecting the NHS? It truly is not understood by people at a local level how the Government have made—as they have—really substantial increases in health spending when the local media is dominated by reports, as in Norfolk, of the possible closure of all nine of the county's community hospitals. They ask—they are right to do so—how care in the community can become a reality if community beds are to be axed. They ask whether Ministers and those who plan such things really believe that it is an inviting prospect for a vulnerable person, being discharged from hospital after surgery, say, to have to miss out the half-way house of community beds. Dame Denise Platt said:

That is not an inviting prospect.

However, the Government’s intentions in this policy area are admirable. They have shown remarkable energy. There have been real increases in spending on health. But the question posed by the debate is whether appropriate priority is being given to investment in the social care workforce. At this stage, that has to receive a very qualified answer, “Perhaps not”. As Dame Denise said:

Quite so.

12.10 pm

Baroness Barker: My Lords, I, too, thank the noble Earl, Lord Listowel, for introducing this debate in a most interesting way. I do not intend to take him on philosophically, but I think he hit on something rather important. He talked about social care in Europe, but he did not mention that in mainland Europe a great deal of social care is provided by charitable, religious or sometimes trade union organisations. It is largely informal and it is

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subsidised. He mentioned Denmark, which is noted for the high quality of its social care services, but it has a very high tax base and a very high level of public expenditure. That is why I think he is absolutely right to set this debate now. The central question that we and the Government have to answer is: what kind of social care system do we want and how are we going to pay for it? Noble Lords this morning have talked about the raft of policy documents, including Options for Excellence, which set out a vision for social services that is on a par with Denmark. However, what was missing was the realisation that to achieve that there must be resourcing and the question is: where are those resources going to come from?

A central issue to the debate is that over the past few years the nature of social work and social care has changed. Years ago social care was a largely unregulated area of work and it relied on low-skilled and low-paid local workforces. During the past decade, it has become increasingly regulated and reliant on staff who are highly skilled. The problem for local authorities is that, unlike in the health service where there was the Agenda for Change analysis—a huge programme that looked at the skill sets needed to deliver care and an equation of that with remuneration—there has until the publication of Options for Excellence been no similar systematic analysis of what is needed in social care.

The fact that there is a need for greater skills is not in dispute. People are living longer with rising levels of physical disability and a growing incidence of dementia. People with disabilities are surviving into adulthood and they are expecting the intensive care packages which they had as children to continue throughout their lives. For several years, extensive, well researched reports from everybody from the Social Policy Ageing Information Network through to Sir Derek Wanless, who did an exercise for the Treasury, have set out quite clearly that social care is running anywhere between £1 billion and £2 billion in deficit. That is the point from which we start.

Local authorities can do one of two things. First, they can reduce the scale of the services they provide. The CSCI report published last week, very good though it was, was absolutely no surprise. It is no surprise to anybody who works in social care that only critical and substantial needs are being met. Indeed, many local authorities are only funding critical needs, nothing more. The CSCI report was right that unless local authorities have an injection of resources, they cannot do more. However, that does not match public expectations because we know from many research studies that only 10 per cent of the general public expect to fully fund their future care costs.

The other thing local authorities can do is cut costs, and in social care 80 per cent of costs are staffing costs. They can cut salaries, staff numbers and training budgets. The social care sector is already very diverse. Two thirds of social care staff do not work for local authorities; they work in the independent and voluntary sectors. Increasingly, services are being put out to contract through very

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commercial tendering processes. It is not unusual now for voluntary or private organisations not to meet social care commissioners. They meet procurement officers and procurement officers are only interested in one thing: that is, the cost.

It is also not unusual among private care providers to find practices such as staff having to pay for their own training, with the time that they take for training coming out of their annual leave. Such reductions in overhead costs enable those providers to win the contracts in the first place.

There is a hidden cost to all that, which the noble Baroness, Lady Pitkeathley, mentioned indirectly. The more that services are awarded under contract competitively, the more that you lose the public service ethos and the continuity of staff with clients that is part of the great value of our social care system. A huge loss of expertise and experience comes about through the churn of social care staff.

One policy initiative that has an effect on this is the expansion of direct payments and individual budgets. It is agreed that recipients of social care services should exercise greater choice and be able to commission services much more flexibly. That is to be welcomed. However, less widely recognised is the potential in the expansion of direct payments and individual budgets for the emergence of a second-tier workforce in social care. If people choose to rely on informal, unregulated family carers for whom they have been given a budget, those with the most severe needs may have an opportunity to see highly skilled, regulated social care staff, but the vast majority of people with low-level needs who want small interventions will be going back to a social care workforce much more reminiscent of that in years gone by.

The noble Earl, Lord Listowel, is right in this debate to ask the Government what sort of social care workforce we need to meet their policy aspirations. If we are to have one that fits the aspirations in all the policy documents that we have seen, we will need to see a vast injection of resources in CSR07.

12.17 pm

The Lord Bishop of Ripon and Leeds: My Lords, I, too, am grateful to the noble Earl for giving us the opportunity today to affirm the work of social carers and the need to provide them with better support as they serve many of the most vulnerable in our society.

I believe that there is still a temptation to regard the vulnerable elderly in particular as out of sight and out of mind. Although no one would acknowledge this, the attitude is there fairly deeply in some parts of our culture. It cuts across the Christian view that all human beings are made in the image of God and are always precious to God. It also cuts across the aims and thinking of a humane society, which I hope and believe have moved beyond the logical positivism of which the noble Earl spoke. The Church of England has sought to address this in attempting to put its own house in order in its recent publication, Promoting a Safe Church.



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We hear much in these discussions, as noble Lords have said, of efficiency drives and the need to get the best value from our care force, but what would most help in achieving that is a change of culture and thinking. If we valued our elderly citizens and those, for example, with learning disabilities better, we would be prepared to pay those who care for them better. I believe that that would do much to ease the problem of carers who quickly move to other jobs and that it would give an incentive for an improved framework for training and long-term development of individuals. The Wanless report 2006 calls for a tripling of spending on older people’s care, a modest shift of 1 per cent of GNP that would transform the situation, but our culture of suspicion is such that we lack the political will, and I think the cultural will, actually to do that.

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