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That has since happened. The result was felt immediately in an increase in turnover of understanding staff. This is a very serious point, which needs to be taken into account. Therefore, I was extremely concerned to find such a strong focus on “commissioning” in Options for Excellence. Why do I say that? All too often throughout the criminal justice system—and we shall debate it further next week in the Offender Management Bill—this Government seem determined to commission services from the private and voluntary sector. This is not to say that that is a bad thing; I am all for getting the right services at the right time and in the right way, but they must be the right services at the right time and in the right way. However, when all the evidence from children and experienced people who work in these homes shows that it is important to maintain continuity and make use of such experience, it is dangerous to risk throwing that away in favour of the mantra of commissioning and contracting everything.
Why do I say that? One day, I inspected Stoke Heath young offender institution, where there was a juvenile element among whom there had been the most horrendous amount of bullying, leading to injuries incurred by youngsters. The bullying had been carried out not just by the youngsters but by members of the staff, and injuries had been caused during official procedures of control and restraint. The staff there appealed to me to inspect them and to comment that they had not been trained to do the job.
I am concerned that we have untrained staff in places where juveniles are looked after—and we are talking about training here. Why can we not pick up the remark of the noble Baroness, Lady Shephard, about the need for joint working in all this training? She mentioned the National Health Service and the social services. I would mention the need for the Prison Service and others which look after juveniles to get involved in the training as well, because the “so what” of not getting this right is that more and more young people will enter our prisons. I was horrified to discover how many young prisoners have already experienced care, but I believe that that will be avoidable if we listen to what has been said and incorporate the need for continuity of staff as a major, rather than a minor, add-on to what is otherwise an admirable paper.
1.21 pm
Baroness Scott of Needham Market: My Lords, I thank the noble Earl for tabling this topic for debate today. As we have heard, the social care workforce consists of the people on whom many of the most vulnerable in society depend. They face a variety of challenges, so a debate on the subject is welcome.
In summing up, I shall concentrate my remarks on the situation faced by local authorities. I do so because, first, they are the major employers of social carers and, secondly, as a former leader, it is the area that I know best.
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Local government has been facing a fairly tough financial outlook for some years now. The Government argue that it has had a 40 per cent increase in funding during the past 10 years. On the other hand, local government argues that much of that money has been ring-fenced for schools and that therefore the actual amount of money available to councils to spend on all services, excluding education, has been around 14 per cent. Where the balance of that lies is not for debate today, but the fact is that actual spending by local authorities has gone up by 50 per cent over the past decade. The balance has been met by the council tax payer, and the results of that are evident to everyone.
During the past decade, councils have faced growing demands for their services, particularly in social services. The number of people aged 85 and over has increased by 6 per cent per annum. As the noble Baroness, Lady Shephard, pointed out, their needs become more complex and they require a very high level of care. As NHS budgets have been squeezed, almost half of local councils have reported a reduction in PCT support for joint projects. An LGA survey carried out last summer showed that 70 per cent of local councils had been adversely affected by actions such as bed reductions and community hospital closures. In fact, just this week the Local Government Chronicle carries a report which estimates that the cost to Brent council alone of what it describes as the “PCT cost shunt” is around £9 million, and that is threatening joint arrangements and partnerships at all levels of care.
The Government have rightly made education a priority and have protected education budgets through ring-fencing. However, this means that, when local authorities seek to rebalance their budgets, because social services take by far the largest share of what is left, social services’ budgets take the hit most of the time. Currently, councils are spending about £1.8 billion above the amount allocated to them, and the difference can be met only by increasing council tax or by cutting spending.
According to the Commission for Social Care Inspection, increased demand has already lead to,
Wanless made similar comments. He said in his report:
One could argue that that is because local councils are inefficient and are failing in some way. However, all the evidence suggests otherwise. Local government now has a strong record on financial management and service improvement, as judged by the plethora of external inspecting bodies which the Government have created. The Audit Commission’s performance assessment shows that 68 per cent of councils achieve three or four stars and that they are far outperforming the NHS. In November, the Commission for Social Care Inspection reported that local authorities had improved
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It looks as though, on current trends, by 2009-10 local authorities will no longer be providing care and support to those with low and moderate needs. These are the people who need only a little help to be able to remain in their own homes, which is what most of us would wish for. In this country, we currently provide home care to 370,000 people—a low figure by international comparisons. Studies have shown that 45 per cent of carers are family members and that it is becoming increasingly unsustainable to keep transferring the burden on to them. Research also shows that relying on an unpaid workforce comprised mainly of women will not work in the future, because, for a variety of reasons, younger women are less willing or able to provide that level of care.
We need to maintain a committed and appropriately trained workforce in order to achieve quality care. The drive to manage costs cannot be entirely at the expense of a workforce which we know needs to be of high quality. The noble Earl, Lord Listowel, rightly referred to the huge strides that have been made in driving up the quality of the social care workforce. Social work is now a graduate-entry profession and registration with the General Social Care Council is mandatory. I pay tribute to the work carried out by the noble Baroness, Lady Pitkeathley, and I join her in paying tribute also to the work of the council in driving up standards in social care. Certainly, its vision, set out in Options for Excellence, has the support of us all in general terms.
However, there are problems. Recruitment and retention are already major issues in social services authorities. Vacancy rates are high. Around 69 per cent of local authorities have reported recruitment difficulties in certain disciplines and 49 per cent have reported problems in retention. The occupations with the highest retention difficulties are children’s social workers and home care workers. Today, we have heard some of the reasons why those areas are the hardest hit. In 2005, 20 per cent of the social care workforce in London consisted of agency workers. That shows the particular problems faced by the capital.
Keeping pay settlements low may be a necessary objective in some circumstances, but councils, like businesses, need to be free to adapt to the situation in their area, and, as the noble Lady, Lady Saltoun, pointed out, there is a market. But it is an area in which we need to exercise some care. Four-fifths of the social care workforce are women. Many of them are care workers on comparatively low wages, especially in the private sector. Driving down wage costs could not only adversely affect recruitment but damage women disproportionately.
As councils are forced to withdraw care from those with low and moderate needs, the social care workers end up making the assessments which they know will result in hardship for their clients. Dedicated professionals in social care who have entered the field motivated by a desire for public service are being forced to ration care packages or deal with a caseload which they know prevents them giving individuals the sort of attention they deserve. The whole thrust of the
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Council cutbacks can have an indirect effect on social care—for example, where savings are made in administration, training or legal services. The most commonly used measures to tackle the shortage of social workers include training up social work assistants, improving IT and providing training to support staff in other areas, but these are the areas of spending which tend to be cut first because they are not seen as front-line. I know of areas where, for example, case papers have not been properly prepared by hard-pressed legal departments in local authorities due to time pressures. In an increasingly litigious world, it is highly dangerous if cases are not decided on their merits but are somehow lost by default due to administrative problems.
This is the time for the Government to make a serious choice about matching their genuine vision for social care with the means available to fund it. The current practice of pushing the burden on to council tax payers cannot go on. The noble Baroness, Lady Shephard, is right to say that this is now urgent.
I recognise that the noble Lord can say very little today about local government finance and its complexities, but I hope that he might reassure us that perhaps through the mechanism of the Lyons review, the Government will look again not just at the way in which local authorities are funded but the relationship between health, local government and social care.
My noble friend Lady Barker got it absolutely right when she said that the heart of the matter was to consider the sort of social services we want and how they should be paid for. We all share a vision of improved public services offering a better quality of life, working along with the voluntary sector. We would all like to help to achieve that. We need a mature debate, shorn of the sort of ritual of buck-passing and blame, to find a way forward.
1.30 pm
Baroness Verma: My Lords, I too congratulate the noble Earl, Lord Listowel, on initiating this very important debate. The noble Earl is obviously very passionate about the delivery of services to children and young people. His facts and statistics reveal the great difficulties facing local authorities and providers. All noble Lords, with their expertise and knowledge, have posed many questions to the Government. I look forward to the Minister’s response.
In another place, my colleague Tim Loughton has set up a commission to look into the role, status and future of social workers. The Conservative Party is very keen to see the sector examined and developed properly. We are delighted to note that the noble Lord, Lord Laming, and the noble and learned Baroness, Lady Butler-Sloss, have agreed to be patrons of that commission, and that my noble friend Lady Morris of Bolton is a member of it.
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I declare an interest as a health provider. My remarks will be based on my experience in the sector. As a provider, I know the difficulties of an untrained workforce or one that has training that is sometimes inappropriate or does not meet the needs of service users and their families. We need to look at health and social care as two sides of the same coin. We cannot separate them off. While billions of pounds have been spent on the NHS, the social services sector has had insignificant responses to the pressures put on it. We know that the NHS can show tangible results, but in long-term care, such as care for children, we do not see tangible results. Support, care and long-term commitment must be given to people who are dependent on care staff and social workers.
As a provider I have had difficulties with the qualifications of care staff who have poor literacy skills or whose first language is not English. Care out in the community is changing and more and more nursing care is being imposed on care staff. Social workers are given a huge workload. Although I congratulate the Government on their White Paper Our Health, Our Care, Our Say and the Green Paper Every Child Matters, there has to be greater consultation on the sort of support that the Government can offer in developing the training programmes that are offered to social workers and care staff.
I was speaking to our local provider from Age Concern, who agreed that there are great deficiencies in NVQ provision for care staff. I know the difficulties that Age Concern in Leicester has had in trying to roll out the programme with consistency. The retention of people to train care staff to gain NVQs has been very poor. Unless we value the work that care staff and social workers do, the turnover in this sector will always be incredibly high. I am a great believer in training, but it has to be appropriate training. I am pleased to say that Leicester City Council and Age Concern will be piloting a scheme that will look at appropriate training for care staff. They will work more closely with social services and social workers to ensure that there is a match between care provision and what service users require.
I could give several examples of inadequacies in care provision today, but it would mean going round the same issues instead of having a forward look. I would rather work with noble Lords to see how we can improve training and the value put on care staff and social workers. In practices in Leicester we find that we lose staff because the local supermarkets offer more pay, less responsibility and much better flexibility in working times. Care is difficult. A service is expected 365 days a year. There is poor provision in respite help for service-user families, so informal carers end up needing care.
I had a deep conversation with the noble Earl, Lord Listowel, about children in care and the fact that they want continuity. They want somebody who they know will be there when all else is lost. When nobody else is there for them, they want to know that that one person will see them through the system;
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The subject is huge. We can top it up with lots of facts, figures and statistics, but it boils down to the fact that we are dealing with human beings who are vulnerable and less able to reach out. They are often the quietest, so they do not make a noise when they do not know how to access the services that they duly and rightly should have. It becomes a vicious circle. We have to be the voices, often not just for the service users but for their families to show them where to access help as they themselves are so poorly informed.
As my noble friend Lady Shephard said, there has to be greater joined-up thinking and management, and a greater exchange of training. Local social services have in-house training, but private providers have to find funding and search for training. If they do not find funding, it becomes another cost implication in a sector that is poorly paid. I do not believe that throwing extra money around is always the answer, but appropriate training and negotiations with partners in the health and social services sectors can resolve some of the problems.
Before the debate, I spoke to a number of children in the care sector and from families with needs due to drug or alcohol abuse in the home setting. We developed a sort of thinking, which may sum up some of the difficulties which cannot be topped up with statistics or numbers. A child said:
“I know I’m from a deprived and disadvantaged background. I do not need to be reminded of it. I know that I want to be valued. I want to be given opportunities. I want to make a positive contribution, but I want to be shown how to make that contribution. I want to be shown how to be proud of myself”.
The elderly sometimes feel embarrassed to seek extra help. Children do not know how to seek help. Care staff most often come into the profession because they care about people and want to do their best, but must be resourced to do so with the proper training and respect given to the service they provide. Care staff and social workers do a phenomenal amount for this country, and we do not offer them the status and respect they so rightly deserve. I hope that the Government will work towards ensuring that those groups are offered that status and respect.
1.41 pm
The Minister of State, Department of Health (Lord Hunt of Kings Heath): My Lords, like other noble Lords, I congratulate the noble Earl, Lord Listowel, on his initiative in securing the debate. Like the noble Lord, Lord Low, I welcome debates on social care and hope that we will in future have opportunities to debate some of the many important issues discussed today. The debate has illustrated the inter-relationship between social care and many other desirable objectives of health and social policy. I am sure that we will return to this subject.
I echo the noble Baroness, Lady Verma, when she says that we must ensure that people using services and their carers benefit from a highly skilled workforce. We want them to be valued. We know that
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The noble Earl, Lord Listowel, rightly mentioned the events at Sutton and Merton primary care trust. As we praise, we must also acknowledge that the findings of that investigation were both shocking and saddening. What was happening there was completely unacceptable and action clearly needs to be taken. However, we must set that alongside the tremendous good work that occurs in the sector.
The noble Lady, Lady Saltoun, and the noble Baroness, Lady Howe, asked whether taking children into care is always appropriate. Looking at the outcomes of looked-after children, it is an understandable question. We have debated this matter for a number of years. The outcome for many looked-after children is very poor indeed and the question is therefore valid. The noble Lady and the noble Baroness were right to pinpoint the need for better training and support. We must look at alternatives. I suspect that taking children into care must always be an option, and we should recognise that social workers’ decisions in doing so are difficult. They identify to us how much pressure social care staff come under, working in some of the most difficult circumstances with hard-pressed teams. As noble Lords have mentioned, the workforce experiences high levels of vacancies—persistently around 10 per cent in England—and staff turnover. The level of relevant qualifications is far too low, with around 30 per cent of the workforce having a social care qualification at NVQ level 2 or better.
I accept that noble Lords have been generous in identifying the improvements and some of the encouraging signs we can see. The rise in the number of those training to be social workers—by a quarter since 2000-01—has been notable. The first cohort of students on the new degree, qualifying in 2006, has great potential for the future. We must build on that. The General Social Care Council, Skills for Care, the Commission for Social Care Inspection and the Social Care Institute for Excellence are essential foundations on which to build much greater confidence in the social care workforce.
I pay tribute to my noble friend Lady Pitkeathley for her outstanding work. She is right to suggest that continuing the recruitment campaigns is important. They have been successful and we will continue with them. My understanding is that there will be another
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Noble Lords have mentioned that we have put more resources into training. The GSCC has opened the register for social workers, for protection of title and so on. I understand why my noble friend Lady Pitkeathley asks for the extension of registration to other workers in social care. We are giving that due consideration.
The noble Earl, Lord Listowel, rightly drew attention to the particular vulnerability of young people and the fact that many of the care workers they deal with change, reflecting vacancy and turnover rates over the past few years. In the social care workforce employed by local councils, vacancies are around 10 per cent; that is uncomfortably high, although it is a reduction from 11.5 per cent in 2001. The rates are higher for social workers at 11 per cent, and higher still for some other staff, such as occupational therapists at 14 per cent. Residential child workers are a long-term problem with vacancies at 15 per cent. That is a major challenge, not just for statutory providers.
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