I hope that we will be able to provide a response—assisted, no doubt, by the commission of the noble Lord, Lord Bach, although the timings may not precisely coincide—to some of the matters that have arisen from LASPO. The purpose of LASPO was, of course, to reduce the cost of legal aid and to try to focus legal aid where it was most needed, in the most important cases. The noble Lord, Lord Bach, has been a consistent critic of the effect of the lack of legal aid in social welfare cases and I understand this concern, but I think he and the House would agree that not all problems that come from social welfare difficulties—

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particularly debt, for example—are best approached by lawyers. That is not to undervalue the lawyers’ contribution, but lawyers, at whatever hourly rate they charge, may not be the best people to sort out, for example, the many debt problems that beset those people who have social welfare problems.

A number of noble Lords mentioned the question of the process for solicitors’ legal aid contracts. There was criticism from the noble Lords, Lord Marks and Lord Cotter, of the whole process by which such contracts are obtained. This process is the subject both of litigation in respect of the procurement process itself and also judicial review in respect of those contracts. It would not be appropriate for me to go into much detail about that, save to say that the Ministry of Justice, as I have said previously from this Dispatch Box, is satisfied that the process was fair and will maintain that in court. The noble Lord, Lord Cotter, returned to an issue he has raised in this House before about a geographical problem with solicitors being outside of a necessary area. I can tell him and the House that bidders would be required to have, or commit to have, an office in the relevant area where the work was delivered. That would be a matter taken into account.

The Law Society acknowledged that there was a need for some consolidation. Fortunately, the crime rate has dropped and the process was undertaken in a way that we think was appropriate to make sure that taxpayers’ money was well spent but that, nevertheless, there could be access to the duty solicitor scheme. Of course, solicitors will still be able to have the own-client system and they will be able to provide, as agency providers, services that they have hitherto provided.

Litigants in person are undoubtedly a feature of the current system, but a number of initiatives have been undertaken; and not simply pro bono, although I entirely endorse the importance of the pro bono sector and the valuable work done by solicitors and barristers in this connection. There is support taking place across England and Wales; for example, the LawWorks clinics network, which provides a local face-to-face and telephone advice service for litigants in person, predominantly in the area of social welfare law. The network has continued to grow and has 220 legal advice clinics in England and Wales, supported by volunteer solicitors, barristers, trainees and law students. That is just one example of the strategy in action across England and Wales to support litigants in person. There is also a national campaign launched this autumn to raise awareness of the help available to litigants. Postcards and posters will be distributed widely.

The strategy is not of course the only answer. There are numerous schemes going on nationally and also at a local level. I heard about some of these developments at the Civil Justice Council’s fourth National Forum on Access to Justice for Litigants in Person, which I attended last Friday. It was well attended by representatives from across the justice system and I was struck by the level of expertise, experience and enthusiasm shown by delegates to maintain the momentum that has been building for litigants in person.

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Much has been done in this process. A simple rule change—rule 3.1A—is helping in this regard. The noble and learned Lord, Lord Woolf, was unfair to himself in suggesting that the CPR had not been a total success. In many ways it improved a great deal the system which prevailed under the rules of the Supreme Court—the predecessor of the civil procedure rule. With respect, he is right that it has not prevented disputes being very expensive. Certainly, the reforms that we intend to bring forward in our civil justice system, using the increasing availability of technology and reducing the number of court hearings, will build on those reforms. Rule 3.1A, on “case management—unrepresented parties” will encourage judges when dealing with litigants in person to use language and a way of dealing with them which is wholly different from the way it was used before. Simple illustrations were given at the meeting to which I went that the terminology is mysterious. What is an appellant? What is a respondent? Ordinary language will help. In the new climate that we live in it was encouraging to see so many judges attending this civil justice forum who deal with litigants—

Lord Woolf: I am very grateful for the comments made by the noble Lord. What about Latin?

Lord Faulks: We are very much discouraged from using Latin in any context now, although I do not know whether the noble and learned Lord would agree that it is remarkable that when you are told not to use Latin, it becomes almost irresistible to use it and somehow will only serve as the correct way. It is very much a thing of the past, I think.

Lord Lester of Herne Hill: In deference to the noble and learned Lord, Lord Woolf, will the Government reinstate the word “writ” instead of claim form?

Lord Faulks: I share the noble Lord’s dislike of that expression but I cannot give any commitment at the Dispatch Box on that matter.

Mediation is not, I entirely accept, a panacea but the Government have done a great deal of work on mediation. It is clear that the courts need to be concerned with most decisions of great importance but we need to encourage mediation. We have taken a number of steps to promote family mediation and its benefits. From April last year the Children and Families Act 2014 made it a legal requirement that anyone considering applying to court for an order about their children or finances must first attend a mediation, information and assessment meeting, unless exemptions such as domestic abuse apply. On domestic abuse, we have changed twice the evidence requirement, to make it easier for legal aid to be obtained for domestic abuse.

From November last year we fund the first single session of mediation in all cases where one of the people involved is already legally aided. In this scenario both participants will be funded for MIAM and the first session of mediation. So, I am pleased to share with the House that the number of people starting legally aided family mediation has increased over the last year and is at its highest volume since April to June 2013.

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Legal aid remains a vital part of the system. It was brought in by the Attlee Government post-war and remained part of a significant improvement to social justice. This Government do not want to abandon legal aid. We are, of course, suffering under financial constraints but that does not mean that we should not be directing our attention to ensure that access to justice can be obtained, partly by legal aid and partly by improving our justice system in the various ways touched on in the course of this debate.

The Ministry of Justice remains open, as I hope has been indicated by the Lord Chancellor’s response to one or two areas, which may be characterised as U-turns or, more properly, further consideration. I do not consider the capacity to change course to be a weakness and I hope that noble Lords will agree about that. The lessons that we learn from LASPO will, I hope, inform policy-making. We remain under significant financial constraints. However, there is no reason to abandon our commitment to access to justice. I am grateful to all noble Lords, all of whom I know share the Government’s commitment, for bringing these matters to the attention of the Government and to the House.

2.26 pm

Lord Howarth of Newport: My Lords, I add my thanks to the thanks just now expressed by the Minister to all noble Lords who have spoken in the debate. Without exception, noble Lords have spoken with deep feeling about the problems of access to justice that have been intensified in consequence of the LASPO legislation. Some strong language has been used but, I think in these circumstances, very justifiably.

The debate has been informed by deep experience. My noble friend Lady Mallalieu spoke of her 40 years’ experience as a legal aid lawyer; my noble friend Lord Clinton-Davis capped that by referring to his 60 years of experience; and then the noble and learned Lord, Lord Woolf, said that he, too, had come into the law at about that same time. Of course, that was an exceptional vintage.

We also had the very important and eloquent contribution of a former Law Lord, the noble and learned Lord, Lord Brown of Eaton-under-Heywood. As my noble friend said, we miss the expertise of the noble Lord, Lord Pannick, but he finds his ways to share that with us. Many noble Lords spoke of the pride that historically we have had in our system of justice. The noble Lord, Lord Lester, and my noble friend Lady Dean were eloquent on that. Amidst all this wealth of expertise and profound experience, I was glad to be joined by at least a handful of amateurs, to use the term used by the noble Lord, Lord Dykes, to characterise those of us who have the misfortune—or possibly the fortune—not to be lawyers.

My noble friend Lord Judd reminded us that justice is at the heart of so many different policy issues, and other noble Lords were specific about areas of present injustice about which they are deeply concerned, such as domestic violence and the predicament of disabled people. The noble Earl, Lord Sandwich, spoke of the plight of asylum seekers, trafficked people and Syrian refugees to come, who will need to be able to obtain justice. My noble and learned friend Lord Goldsmith

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spoke about the disproportionate effect of many of the changes that have taken place on the predicament of women. My noble friend Lord Knight of Weymouth spoke with particular eloquence and passion about some cases that he has studied. I wish him well—and his friend Emily very well indeed—in the work that they are doing in their part of the country. He spoke, quite rightly, of the human cost of doing justice on the cheap.

A number of suggestions for reform were made. The noble Lords, Lord Cotter and Lord Marks of Henley-on-Thames, discussed procurement. The noble Lord, Lord Marks, also drew attention to the Leveson reforms, and the noble and learned Lord, Lord Brown, referred to the recommendations of Sir Bill Jeffrey. The noble Lord, Lord Low, was able to draw from the depth of his experience in chairing the commission that he has chaired in successive instances, and his ideas for a better network to enable the availability of justice are important and should be heeded. I think that after 50 years, the noble Lord, Lord Low, is entitled to submit the three volumes that his commission has published, plus the text of his speech today, for his PhD. It is time he gained it.

Many noble Lords spoke of their admiration for the legal profession. My noble friend Lord Judd made that point strongly. My noble and learned friend Lord Goldsmith spoke with pride about the Bar Pro Bono Unit, which he founded. We should all take this opportunity to thank so many members of the legal profession—indeed all of them, I would like to think—who, whether paid or unpaid, are dedicated to ensuring that justice is in truth and in reality available.

There was considerable discussion about the current state of the legal profession and of the courts. There was pretty well a consensus that there are very serious problems at the criminal Bar. The noble and learned Lord, Lord Judge, talked of a brain drain happening at present, as people leave the criminal Bar. The noble and learned Lord, Lord Brown, underscored that point in this most crucial area of legal practice. There is a crisis. My noble friend Lady Mallalieu told us of lawyers who earn less for their brief than the cost of the train fare to court. Clearly, if that is the case, the system is not sustainable.

The noble Lord, Lord Lester, helpfully introduced into the debate the issues of exceptional case funding and the fall in the incidence of mediation. The Minister, in his reply, accepted that those were indeed issues. The noble and learned Lord, Lord Woolf, said that it was a critical time for the administration of justice, and it would be no easy task to undo the damage that has been done. There was also some valuable discussion of the case of LIPs—litigants in person.

I want to add my personal tribute to my noble friend Lord Bach, because the scrutiny he led of the LASPO legislation and its subsequent emanations has been wholly admirable, and I have found him persuasive—at every point, I think. I wish him well in the work of the review that the leader of the Labour Party, Jeremy Corbyn, has asked him to undertake, and I indeed hope that we can move towards a consensus.

I also thank the noble Lord, Lord Faulks, the Minister, for the generosity of his remarks, the tone of his speech, and his willingness to acknowledge that

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there are lessons to be learned from LASPO, and that all is indeed not well. He spoke about various issues on which he and his colleagues in the Ministry of Justice are at present working. He also wished my noble friend well in his work on the commission. I hope that he and the Government will be assisted by my noble friend’s work, and that we shall achieve the consensus that we all desire.

Motion agreed.

Conflicts and Violence: Religion

Question for Short Debate

2.32 pm

Asked by Baroness Berridge

To ask Her Majesty’s Government what steps they plan to take to tackle the rise in religiously-identified conflicts and violence, in the light of the recent visit by Pope Francis to the Central African Republic.

Baroness Berridge (Con): My Lords, I am extremely grateful to all noble Lords who will speak in this afternoon’s debate, as the Central African Republic is not a well-known country and does not get the attention its people deserve. Also, I accept that the global trend referred to in the title of the debate reads rather like a question for a PhD thesis, or at the very least the title of a book by the noble Lord, Lord Sacks, Not in God’s Name, which I commend for your Christmas present list.

Only 12 years ago the Prime Minister’s communications director said, “We don’t do God”, which was taken to mean nowhere at all, domestically or abroad—rather unfairly taking it out of context. The context was an interview about the Iraq war: sadly, events have shown that talking God should have been left in the script. If we were to track today the frequency with which the words “theology” or “religion” are being used by UK politicians and media outlets, we would see that this is the time of renaissance. “Renaissance” is the right word—lest we forget that we did do a lot of this kind of violence in this country’s past. I am sure that media commentators in Tudor times would not have found this topic at all out of the ordinary—although they would not have used “religion” or “secular” in this context, those being post-Enlightenment terms.

The secularisation thesis propounded by the likes of Peter Berger in the 1960s was, by his own humble admission in 1999, “essentially mistaken”. The world at the end of the 20th century got seriously more religious, and religious people are not huddled in a corner, oddly out of step with the modern world. Today 84% of the world’s population profess a religious faith—and not just a “tick-box on the census” type faith. The world has got more religious, more devout, and that is the predicted future trend. In 2010, 16% of the population was unaffiliated to a religion, and Pew research predicts that by 2050 this will fall to 13%. We here reside in what is now termed “western European exceptionalism”, which requires from us a degree of caution when we look out from this window at today’s complex world. Another relevant, potentially infamous,

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theory—Huntington’s clash of civilisations—has been robustly critiqued, but I think we are left with the awareness that it is not only land, political power and scarce resources that can lead to conflict, but values, ideas and identities, some of which are of course religious.

As co-chair of the All-Party Parliamentary Group on International Freedom of Religion or Belief, I have read of rising violence against atheists in Bangladesh, Shia and Ahmadiyya Muslims in Pakistan, Yazidis in Iraq, Muslims who speak out against Boko Haram in Nigeria, Baha’is in Iran, and Christians in all those countries, save potentially Bangladesh. That violence is often mob violence with the state turning a blind eye, but most cases are at the very least identified as religious, and it is hard to deny the religious motivation behind much of that persecution.

In addition to mob violence, religion is documented as a factor in many civil wars. The empirical analysis in God’s Century by Toft, Philpott and Shah—another book for the Christmas list—is that, between 1940 and 2010, of 135 civil wars 44 were religious. As of 2010, 50% of the 16 ongoing civil wars had a religious basis—up from 22% of civil wars in the 1960s. They assert that religious civil wars tend to last longer and kill more people, and make it harder to achieve a sustained peace. However, perhaps the most dangerous element is that religion is a transnational phenomenon, so these wars are more susceptible to spreading from their home territory or attracting foreign fighters.

There is also a rise in global religious-based terrorism: it existed in about 20% of countries in 2012—up from 9% of countries in 2007. This can be found in every major religious tradition. Mark Juergensmeyer’s analysis of the motivations behind Timothy McVeigh, the Oklahoma City federal building bomber, is sobering reading for any Christian thinking that our involvement is a thing of the past.

The danger in this debate, as outlined by the UN special rapporteur on freedom of religion or belief, Heiner Bielerfeldt, is to go to the extremes. One extreme is to ignore religion completely as a motivating factor in violence and always to explain violence in terms of land, scarce resources or political power—causes we are much more comfortable talking about. For instance, race alone seems more amenable for us to talk about in relation to the violence against the Rohingyas in Burma. It is a complex matter, but their Muslim faith in that Buddhist-majority country should not be discounted.

The other extreme is blaming religion too quickly, and excusing the human agency and responsibility that is the ultimate cause of all violence: ideas and theology cannot kill, people do. But if religion is a factor in conflict, terrorism and persecution, it may also be a factor in establishing the peace. This seems to be the season of requests for increased religious literacy training for journalists, politicians and civil servants. I note the report by the commission recently chaired by the noble and learned Baroness, Lady Butler-Sloss.

The issues that I have outlined are some of the most complex and context-specific issues that we have to consider; there are few soundbites but much nuance. The Foreign and Commonwealth Office led the way in

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the last Government with seminars on world religions, but can the Minister outline what training in the complexities of ethno-religious violence and conflicts is being run either in the FCO or through the conflict stabilisation unit?

The words of the title of this debate were carefully chosen, because the history of the Central African Republic is not one of religiously motivated or identified conflict; it is only in the last three years that this has become an accurate description. The Central African Republic’s population has now divided along religious lines, with Seleka rebels seen as the Muslim protection force and anti-balaka their Christian equivalent. Most of the Muslims have fled to southern Chad and Cameroon, and there is now a full peacekeeping operation with 10,000 troops, along with 900 French soldiers.

Britain is in a leadership role. Britain is a permanent member of the United Nations Security Council and in this financial year will contribute £33 million to the UN peacekeeping operation, in addition to anything from our aid budget. The key input for the United Kingdom to support our contribution must be the focus on disarmament, demobilisation and reintegration of the armed militia, especially the child soldiers, who number somewhere in the region of 8,000 to 10,000.

Since 50% of DfID’s budget is now to be aimed at fragile states, CAR’s DDR programme must be a priority for funding. There will not be a lasting peace there without it. I was told in answer to a Written Question I posed that just under £18.5 million is budgeted for DDR in MINUSCA’s budget—that is the UN peacekeeping operation. But “budgeted” does not necessarily mean the same as “funded”. If the UK were to put in, say, £5 million, many countries would follow suit, as it seems would the World Bank. Will my noble friend the Minister please outline how much of the DDR budget is funded and specifically request DfID to look at additional funds?

As vital as the UN peacekeepers are—some have died in the Central African Republic, and the French have lost four troops as well—I have learned that this operation is different in capacity and expertise from a NATO-led operation or a British troop-led operation. The five military staff officers that the UK puts into the UN peacekeeping force in the Congo are making a huge difference in providing specific skills, mentoring others, sharing skills and imparting knowledge. The UK could make a vital contribution to MINUSCA in CAR in that respect. I ask my noble friend to make that specific request to the Ministry of Defence.

The Pope’s bravery in going to a war zone cannot be overestimated. Seeing him in his open jeep while the media were in armed convoy was inspiring. This beautiful country, the size of France and Belgium put together, with some of the most fertile land in the world and a population of only 4.5 million to sustain, is—as I have mentioned before in your Lordships’ House—in the category of “doable” in international terms. Only the Pope’s profile made CAR topical for the criteria to obtain today’s debate. My fear is that it will return to being topical when young, unoccupied, angry men, currently refugees in southern Chad, turn up in IS. I will welcome being proved wrong by a little more support from the UK.

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2.42 pm

Baroness Kinnock of Holyhead (Lab): My Lords, at the outset I thank the noble Baroness, Lady Berridge, for her excellent introduction to the issues that we are discussing, and for her constant support and interest in her concerns.

After a referendum on 13 December on a new constitution, a general election is scheduled in the Central African Republic for later in the month. It is a country which has endured political instability and, as we have just heard, episodes of extreme violence since its independence in 1960. The most recent turmoil erupted in March 2013 when the Seleka Muslim rebels overthrew the president. Sectarian warfare took place between Seleka Muslims and the Christian anti-balaka groups. That has generated the most violent instability that we have seen and it has lasted ever since. In these conditions, the hope is that constitutional change and elections can at last produce a Government who can restore peace and order and pave the way for the exit of the UN and French peacekeepers.

The deeply sad reality, however, is that the legacy and current prevalence of severe and savage instability in the CAR means that the prospect of such progress is just not feasible. More than 5,000 people have died in fighting between Muslims and Christians. This assessment is based on a count of bodies and of numbers gathered from survivors, priests, imams and aid workers in more than 50 of the most affected communities. The miserable suffering of the people of the CAR goes on and some 20% of the population are now internally displaced or forced to flee to neighbouring countries. In the north and the east there are no hospitals, schools or roads. In the capital, criminals continue to stoke the tension and insecurity, which plainly serves to exacerbate the already desperate situation.

The Central African Republic has one of the worst economic and human development records in the world. Life expectancy there is 50. Only 30% of people have access to drinkable water. Some 10% have electricity; 5% have sanitation. Against that background, and in an effort to deal with the crisis, a constitutional referendum is now planned and a two-stage presidential election is scheduled for late December and January.

Is it not of some concern, despite warnings by the Electoral Commission and civil society that more time is really needed, that the decision to hold an election before the end of the year has still been taken? Surely the international community should now be working to avoid holding a hurried election, which at this stage would serve only to fuel the already difficult prevailing instability in that country. Is it not relevant that an independent and respected African think tank has said that the CAR will not be able to manage anything approaching a free and fair election because there simply is not the ability to provide security, or to guarantee that all eligible voters will actually be on the electoral roll at all?

With such dependable evidence available, does the Minister agree that there is a strong case for a delay until later in 2016 so that elections can be held in a more peaceful climate and with greater possibilities of coherent electoral organisation? Is that case for delay not made even more emphatic when it is painfully

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clear that the disarmament, demobilisation and reintegration process agreed in May is now very seriously off track; when there is a patent lack of political will and commitment among armed groups and the CAR political elites; and when continuing criminality and intercommunal violence mean that the electoral process could not be effectively managed? If the Minister does not agree with this assessment of the situation, could we please be told why?

Surely there has to be local ownership of the electoral process. The people affected must be respected and their views must, of course, be listened to. More has to be done to achieve those basics before rushing into an ill prepared election. The electoral budget needs to be finalised and the process for selection of candidates in legislative and presidential elections agreed. As we in this Chamber know, these are huge tasks that will take a great deal of time. In addition, there are other substantial obstacles, including insecure voting facilities and the very large number of displaced people. All those issues need to be addressed and resolved in what is a very short timescale. Does not the call now have to be for efforts to encourage reconciliation between communities and for international attention to the tragically chaotic situation in the Central African Republic?

The situation is indeed appalling. The international community must obviously remain engaged to offer support to those enduring a cycle of the most terrible conflict. In doing that, it is essential that a shambolic election is not inflicted on a country already bearing the economic and political burdens of deep poverty and unceasing violence.

2.48 pm

Lord Patten (Con): My Lords, if only we had the capacity in this country to do all the things that my noble friend Lady Berridge wishes to see done in the Central African Republic. If we had the capacity, the capability and the money we could do an awful lot, but we have not got it there or in much of the rest of the world where we all wish to see her words spun into action on the ground. That should not stop us saying exactly what she has said. She has shown formidable leadership in the whole of her speech.

It is good that she has mentioned Popes. Popes sometimes put themselves in the line of fire. Pope John Paul II led a very open papacy and was out and about for his pains. In fact, he received pains; he was shot in May 1981 by a Turkish citizen, for reasons that are still unclear. Of course, Pope Francis has been exceptionally brave and shown considerable leadership worldwide in what he has done in the Central African Republic. In the past, Popes have often been pretty martial themselves: they have got on horseback and led papal armies up and down the peninsula of Italy, chopping off the heads of other Roman Catholics on the other side of the argument.

That is what is so interesting and so challenging about the words in my noble friend’s question: “religiously identified conflicts”. It is sometimes very difficult to identify exactly which strand of religion or which manifestation is causing the conflict. If we look at what is going on in the Near East and the Middle East

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now with ISIL or Daesh—or whatever the politically correct term this week is for those bodies and what they are doing to each other—they have killed far more followers of Islam than they have killed Christians or anybody else. The one thing that unites the Sunnis with the Shias, whom they despise, is their joint dislike of the Alawites, the Ismailis and others on the outer reaches of Islam. In that way they are no different from medieval Christianity in the west of the Mediterranean going across to medieval Christianity in the east of the Mediterranean during the sacking of Constantinople. There are considerable difficulties, however sophisticated the analyses are, of exactly which brand of religion is going to attack which other brand of religion, because they are very often so busy attacking each other.

We see this today in Syria. I will not go over all the excellent speeches that have been made in recent weeks, but there are minority communities in Syria which deserve our protection: the Alawites, the Druze, and various brands of Catholicism, whether western or eastern. If Daesh or ISIL takes over that part of Syria, there will be genocide among those peoples. If, on the other hand, President Assad is still there, whether we like it or not they are protected. We are in a very difficult position and I do not apologise to my noble friend for asking this most difficult of questions. We are now deeply involved in the fate of the Druze, the Alawites and the Catholics because our Typhoons and our Tornados are now going in and bombing in Syria at the same time as we say we no longer wish to see President Assad in power. So I wish to ask the Minister this afternoon: what strategy do we have to protect those minority groups, whichever way this plays out?

The last point that I wish to make is that just as you begin to try to solve a problem in one place, as may happen in the Central African Republic if we do what the noble Baroness, Lady Kinnock of Holyhead, has just said, then something else pops up. Take a Commonwealth country like the Maldives where we have an extremely radicalised Wahhabi Government. More than a couple of hundred young militants have recently left the Maldives, of all places, to fight in Syria at exactly the same time as on the edges of the Maldives we have alcohol-full rather than alcohol-free international hotels staffed by immigrant labour which may in the not-too-distant future be the centre of unwelcome attention from people in other parts of the Maldives. I do not know what advice is given by Her Majesty’s Government on the safety of Christians wishing, for example, to worship in the Maldives. I suspect it is pretty constrained, to put it mildly, in a society where to be a citizen of the Maldives now, you have to adhere to and recognise Islam. You cannot be a Christian if you want to be a citizen of the Maldives. It is full-on Wahhabism there. Recently marine archaeologists found the head of a Buddha which was promptly broken up. So we can see where the next well-scary—as we say in my part of Somerset—threats may be coming around the globe.

2.53 pm

Lord McFall of Alcluith (Lab): My Lords, I am delighted to participate in this debate and I commend the noble Baroness for her consistent advocacy in

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tackling the rise in religiously identified conflicts and violence. There is no doubt that Pope Francis is the most influential global leader we have presently. His simplicity, his spontaneity of language and his attention to the weakest attracts the admiration of many people, believers and non-believers. His visit to the Central African Republic was highly significant. In fact, his visit was in keeping with his namesake, Saint Francis of Assisi, who, during the Fifth Crusade, crossed enemy lines to meet Sultan Malik al-Kamil of Egypt to plead for peace. Francis is mirroring this precisely by visiting this destitute and war-torn land. In fact, he is the first pontiff in living memory to visit a war zone. That comes from his philosophy which was apparent when he was appointed Pope in the Sistine Chapel and he said: “I see the Church as a field hospital after battle. You have to heal the wounds and start from the ground up”. And he did that by breaking with tradition. On the first Holy Thursday he did not wash feet in the Basilica of San Giovanni but he went to a juvenile prison and actually washed women’s feet, which broke with tradition again. One of those women was a Muslim and in his visit to the Central African Republic a central part of it was visiting the mosque because he was emphasising that religious dialogue in the public square is important.

There are lessons for us at home. Here we have a tendency to articulate the notion that anything regarding religion that is disturbing is not religion at all; that real religion takes place in private. I think we have to disabuse ourselves from that notion, because there is a Muslim problem in terms of the misinterpretation of the theology of Islam by some people; there is a Christian problem in the misinterpretation of the theology of the Crusades; and there is a Jewish problem in the denunciations for lack of orthodoxy. Things happen as a result of religion and if meeting together can lead to us acknowledging that there is a religious problem, then participants can explore and attempt a contemporary understanding of the role of religion. We can do no better than continue the tradition of Assisi whereby Popes John Paul II, Benedict and Francis held interreligious summits at which we now have non-believers present.

In 2011 French semiologist and psychoanalyst Julia Kristeva spoke and invited the audience to discern what she described as a complicity between secular humanism, with its origins in the Renaissance and the Enlightenment, and Christian humanism. She reassessed the great moral codes of our tradition: the Bible, the Gospels, the Koran, the Rigveda and the Tao. The most important thing, she stressed, was the criterion of liberty. That is walking with believers and unbelievers, and that is essential. I wish that for our own country and I have a suggestion. Coming out of this House the other evening I bumped into my dear friend the Archbishop of Canterbury and I said to him that I was going to mention him today because I think the Archbishop could call such a meeting. Why do I say that? Because I think that the Church of England above all the churches is under the skin of society. It has a social message which has been loud and consistent over the years. The Archbishop himself, when he took office, set down three criteria. One of the criteria was the concept of good disagreement. That is very important

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in the political and the social field. We can see in America that Donald Trump is generating a bigoted discourse and we must prevent that, so we need good disagreement now more than ever. I spoke to the Archbishop the other evening about it, I told him I was speaking in the House, and no doubt his fellow clerics will take that back and join me in saying, “Justin, you are the appropriate man to do this. Let us get on with it”.

2.58 pm

Lord Alton of Liverpool (CB): My Lords, I, too, welcome this debate and I am grateful to the noble Baroness for giving us the opportunity to discuss the suffering being experienced in the Central African Republic, one of the five poorest countries in Africa and a country of which she has first-hand knowledge. Undoubtedly, Pope Francis has shone a light into one of the darkest corners of the world, explaining that the purpose of his visit to that maimed and disfigured country was to bring its mutilated people consolation and hope.

Since 2013, CAR has been the scene of chronic violence and unending upheaval, as the noble Baroness, Lady Kinnock, has reminded us. Although religious leaders in CAR have insisted that the conflict is ethnic and political, the fighting has divided the country on religious lines, with mostly Muslim rebel forces fighting mainly Christian militias. In the context of intensified violence this autumn, perhaps the Minister can give his own assessment of the effectiveness of the UN peacekeeping force, to which reference has been made, and how its work can be made more effective.

Given CAR’s divisions, how fitting it was that the Pontiff went to both the cathedral and the mosque in Bangui and urged both sides to put down the weapons of war and to work for justice. At the cathedral, he symbolically opened the first door of mercy in what he has proclaimed this week to be a year of mercy. Without this combination of justice and mercy, we will see no progress in the fiefdoms dominated by war lords and their militias. During his visit, Pope Francis trenchantly admonished those who “seek revenge” and warned of “the spiral of endless retaliation”.

In April 2014, the interreligious platform of Catholics, Evangelicals and Muslims committed itself to promote co-existence and mutual respect in CAR. Its leaders were presented with a basket of eggs, symbolising the fragility of the peace process. Welcome local initiatives and a project giving women the opportunity to take part in conflict resolution have subsequently been initiated. Social cohesion, dialogue and mediation will be key if ever CAR is to move beyond conflict. Without it, there can be no stability, no development and no prosperity. Perhaps the Minister can tell us what more we can do to support conflict resolution.

Given the importance of harnessing religious communities, recognised at the 2014 Wilton Park conference on religion, foreign policy and development, perhaps the Minister can tell us what programmes the Government are supporting which engage with faith communities—but not just as a functional network of delivery agents for social projects— and how DfID will harness the faith communities in places like CAR.

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Will the Government closely examine what the C








has to say about faith communities?

The voices of faith leaders should be amplified at all levels by giving them platforms, communications and travel support, so that they can hold national leaders to account, remonstrate with and lead local communities and engage in international debates about their countries.

Returning specifically to CAR, those courageous few working in this dangerous field say that there are no recognisable government or state structures, and that at this critical juncture there is a need for long-term, predictable funding for at least three years to begin to find sustainable solutions to the crisis, including building state infrastructure, establishing essential services and addressing underlying vulnerabilities. Restoring stability in CAR is not a nine-month programme.

We also need to do much more to stop the obscene flow of weapons from countries in the northern hemisphere into countries like CAR, where children are recruited and turned into killers. AK47s become the weapons of mass destruction.

When he replies, I hope the Minister will make reference to the provision of housing for returning refugees and meeting desperate humanitarian needs.

As the noble Lord, Lord McFall, has reminded us, Pope Francis has said that he sees the Church as “a field hospital after battle”. That metaphor could not have a more appropriate application than in the Central African Republic. He also said, when speaking to the United Nations General Assembly in September of this year, that “solemn commitments” which were not followed up on—often, sadly, a feature of United Nations initiatives—could ultimately do more harm than good. What a tragedy it would be if his own initiative in pushing open a door in CAR were not now followed through with determination by the international community.

3.04 pm

Baroness Jenkin of Kennington (Con): My Lords, I, too, thank my noble friend for initiating this debate so appropriately on Human Rights day, for introducing it so coherently and for her long-standing commitment to this troubled country. I thank her for shining a light on this crisis, in which religion has been used by leaders on all sides of the conflict as a means to divide people. Both Christians and Muslims have been targeted by different armed groups.

Although the conflict is portrayed as religious, the group that is most affected is children. The crisis in the Central African Republic is a children’s emergency and they are bearing the brunt of it. Children are being killed. More than 10,000 children under 18 are currently being used by, or are associated with, armed groups. Children are being subjected to sexual and gender-based violence. Many children are displaced and separated from their families, which exposes them to even greater risk of abuse and exploitation. This is not acceptable.

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Let me share with your Lordships the story of a 13 year -old boy, named Francis, from the Yaloke district in CAR. World Vision, working in CAR, met with Francis in June and shared his story with me. At the age of 13, like many other young boys in his community, Francis joined a local armed group after his brother and uncle were killed by community members from a different religious group. He told World Vision that he joined an armed group because he,

“did not want the death of his brother and uncle to go unpunished”.

By the time Francis reached his 14th birthday he had killed five people—four children and one adult. He explained that he had killed these people because they were Fulani, which means that they were Muslim.

Francis is a victim of CAR’s entrenched culture of violence. He has not received any form of psycho-social support to help him deal with his experiences in the armed group. Most aid programmes in CAR are funded only for short periods at a time, often little more than nine months. Psycho-social support and reintegration programmes for former child soldiers like Francis are both desperately needed and desperately underfunded. Often, because they are not short-term programmes but would take at least two to three years to be run effectively, they are not run at all.

So Francis, like many other children in CAR and other fragile states, continues to carry deep scars from the violence. Yesterday at the UNICEF board meeting—I declare an interest as a trustee—we saw a picture of a child just like Francis, but in Southern Sudan, who, with UNICEF support, has given up his weapons and army uniform, has been released by the militia and is going back to his last opportunity of any kind of childhood.

There is an urgent need to support programmes which help to address the violence in CAR, such as trauma healing, a package of psycho-social support for those affected by the violence, and livelihood programmes to help local economies recover from the violence. This should fit in with the commitment in the recently published aid strategy. I am sure everyone in the Chamber will welcome the increased resource and expertise to tackle the drivers of violent conflict that threaten stability and development in countries such as CAR. I hope that some of this increased expenditure might be invested in programmes to support survivors of sexual and gender-based violence in CAR. I encourage the FCO to make CAR a PSVI priority country. I am sorry about all those acronyms.

Work in fragile states such as CAR has always been a key part of DfID’s overall portfolio. Since 2013, DfID has committed £58 million to address the needs of central Africans, central African children and refugees from CAR. This funding has enabled agencies to support children who have been separated from their families, to provide services for boys and girls who have suffered sexual and gender-based violence, to reduce malnutrition and to give children access to education and training. So, when DfID explores new options for programming in March next year, I encourage it to pursue a coherent and long-term approach to its engagement there, including long-term programmes to tackle religious conflict and violence.

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I, too, welcome the courageous visit by Pope Francis, and his commitment to raise awareness of the situation in the Central African Republic and to highlight the need for forgiveness, tolerance and reconciliation in divided communities. This message was heard throughout the world, and my mother tasked me endlessly during his visit to find more coverage on the television. It really awoke an interest. These values are shared by the Christian and Muslim faiths. As the noble Lord, Lord Alton, said, the Pope’s visit to the mosque to deliver a message of peace and reconciliation was a tremendous show of solidarity.

It is important for all involved—Governments and other stakeholders—not to simplify the role of faith in conflict and to draw more on the social capital of faith to deliver stability and reconciliation. Without that, the story of Francis and other child soldiers will become more common, rather than a thing of the past.

3.10 pm

Lord Wallace of Saltaire (LD): My Lords, I am always conscious, when we are discussing the role of religion in politics, that as a small boy I knew that British values were Protestant values and that Catholics were in many ways disloyal and following an alien religion. I did not know any Catholics, but I knew that from reading Charles Kingsley, GA Henty and others. That, I have slowly learnt, was a tribal view, past which I have got except when meeting extremely right-wing American Roman Catholics.

We all know that religion is part of identity and values. It is a way of saying, “I am part of the main group and you are part of a heretical or dissident minority”. Passionately felt, it provides a sense of values but also a real way of distinguishing between those you accept and those you do not. The problem with central Africa is that there is a line between Muslims and Christians, between black populations and Arab populations, between pastoralists and farmers and between a whole host of different things. The rising population has made the competition between pastoralists, farmers and others far more acute, as we see in Darfur at least as much as in the Central African Republic, and as we see in northern Nigeria.

Yes, you know that someone is Muslim because he is a Fulani but you also know that the Fulani are pastoralists and you are much more settled. That is part of the problem that we all have. For people whose understanding of religion is often relatively shallow, we know that it provides a sense of, “I know who I am and I hate you, even though I haven’t met you before”. We have to get beyond that if we possibly can. The answer is clearly to do something about population growth and to help these societies going so rapidly through the transition from traditional society to contact with the modern world with all the reactions against that which lead to fundamentalism in their interpretation of religion. Fundamentalism, after all, was a term invented in the United States by Christians who wanted to insist on traditional Christianity against this dreadful urban, modern, moderate world. As we help them, there is great deal that our Government can do. I want to come back to that in a minute.

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Leadership within religions is extremely important. The Pope’s visit was extraordinarily important. I only wish that we had clearly leadership within the Sunni Muslim world because the absence of leadership there is one of the big problems that we all face at the moment and which the Saudi Government and others need to think rather more about. The sense that different paths to God are possible, and that the different religions that have followed Abraham have something in common in their understanding of God, is the sort of thing that we absolutely have to say to each other, just as we have now learnt to say to each other that Protestants and Catholics actually worship the same God. We did not entirely understand that a couple of generations ago.

We also need to work on the rights of women. These are fundamental to any move away from traditional society. Patriarchy and abuse of religious values go very closely together and have done in a number of institutionalised churches that we had better not name. Population limitation—as far as possible—education, economic development and reduction of inequality all matter, as do open societies and open media. I ask the Government: how far is this an element in their foreign policy as well as in their domestic policy?

The noble Baroness, Lady Warsi, with whom I thoroughly enjoyed working in government, did some very useful work on this. She spoke in Istanbul, in the Grand Mosque in Muscat and elsewhere about the need for mutual understanding between different religions and different societies. I regret, in a sense, that we do not have as coherent a Muslim in government now as we had when she was there. To what extent do the Government think that this continuing dialogue between different communities, different ethnic groups and different religions—of course, these labels all overlap—is still a priority?

3.14 pm

Lord Collins of Highbury (Lab): My Lords, I, too, thank the noble Baroness, Lady Berridge, for initiating this debate and for her ongoing work on this very important subject. During the Pope’s recent visit, the religious leaders of the Central African Republic across all faiths conveyed the same message—that this is not a religious conflict but one about power and politics, which has created a false but very dangerous division.

In the debate last October in Grand Committee, initiated by the noble Lord, Lord Alton, on Article 18 of the Universal Declaration of Human Rights, the right reverend Prelate the Bishop of Coventry highlighted the danger of mixing religion and national identity. He argued that too often the abuse of religious freedom arises from a false collusion between religion and national loyalty. He also referred to the platform for Article 18—IRP18—which brought together religious leaders from various faiths to campaign for global religious freedom. Will the Minister report further on the steps the Government have taken to support such initiatives globally? One example given by the noble Baroness, Lady Anelay, was a project in eastern DRC that drew on the influence of the faith leaders in their communities to challenge some of the attitudes to victims of sexual violence and to address the stigma many survivors face.

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Where freedom of religion or belief is under attack, other fundamental freedoms often face threat too. The Central African Republic, as my noble friend Lady Kinnock said, is a failed state in permanent crisis and has been unstable since its independence from France in 1960. This has undermined the economy and resulted in it being one of the least-developed countries in the world. Its natural resources such as diamonds not only provide a substantial part the nation’s income but drive the communal conflict and political rivalry. Illegal weapons proliferate across the country, with unrest displacing tens of thousands of Central Africans, many of whom cross the border into Chad. Some progress towards stabilising the country was made between 2008 and 2012, but with coups and counteroffensives the risk of genocide was heightened. Instability there affects people not only in CAR but in South Sudan, Cameroon, DRC and other countries in the region. In April 2014, the United Kingdom supported the establishment of MINUSCA, the expanded UN peacekeeping force, French troops returned and the African peacekeeping mission was expanded.

In this volatile situation, there clearly needs to be stability before progress can be made, as my noble friend Lady Kinnock highlighted. President Samba-Panza told the BBC:

“The objective of this transition is to take this country to elections because this is the only way out for us”.

However, with fresh clashes between Christians and Muslims in the capital, the elections scheduled for October were postponed and are now due later this month. The fragmentation and criminalisation of CAR’s armed groups makes negotiations much more difficult, with elections possibly exacerbating existing intercommunal tensions and undoing reconstruction efforts. What is the Government’s current view on the election timetable? Also, what assessment has been made of the threat by a Seleka splinter group to stop elections going ahead in areas under its control, including in the northern region?

There is a clear need for CAR’s transitional authorities and international partners to engage not only with militiamen but with communities. We should incentivise change and provide for effective sanctions if they do not. What is the Government’s current thinking on the maintenance of the UN peacekeeping force and what steps are being taken globally and under international law to reduce the income flow to the various armed groups?

3.20 pm

Lord Ashton of Hyde (Con): My Lords, I, too, am grateful to my noble friend Lady Berridge for initiating this interesting debate, and to all noble Lords who have spoken. I have learned much in preparing for this debate—not all of it, I have to say, encouraging.

As my noble friend reminded us, it can be tempting for us, living in Europe, to underestimate the influence of religion in causing and resolving conflict. Of course, we know that there are often multiple causes of conflicts: for example, high levels of inequality and the lack of opportunities, particularly where they divide people according to their ethnicity and religion,

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can lead to communal violence, especially in times of heightened tensions. Tackling religious conflict requires a fundamentally different approach—not based solely on economics or a political solution but focusing on ideology and winning hearts and minds.

Often, Governments are not best placed to engage in this area. Our contribution must be to create the conditions for others, particularly faith leaders, to preach messages of understanding and love, not violence. For this reason, we are firmly convinced that religious literacy is of key importance for the FCO. If our diplomats are to offer informed foreign policy advice, they must understand the key influencers in the countries in which they work, and in many places religion is perhaps the most significant of those. We hold regular training courses and seminars to further develop professionalism in this area.

My noble friend Lady Berridge asked what training is being run in the FCO. The Stabilisation Unit provides a range of training on conflict issues, much of which addresses the ethnic and religious dimensions. This year DfID is piloting a workshop on religion and conflict for officials working with fragile and conflict-afflicted states. DfID also funded a small research project by the British Academy to examine the role of religion in conflict and peacebuilding. The results were published in September. I hope this goes some way to assuring the noble Lord, Lord Wallace, that the Government think that mutual understanding is crucial and that dialogue is important.

My noble friend Lady Berridge, the noble Lord, Lord McFall, and others spoke about the Pope’s recent visit to the Central African Republic. His visit was hugely symbolic for CAR. It demonstrated that reconciliation is possible and raised the profile of the Central African Republic globally. He raised awareness of the role that faith leaders and faith groups have at a grass-roots level in bringing reconciliation. We welcome the work done by faith leaders in CAR through the religious platform, and we value the excellent work carried out by religious and non-governmental organisations to defuse religious tensions and promote social cohesion at community level. The Pope’s humble approach but firm stance against corruption and violence demonstrated the role that all faith leaders need to play, setting the tone for a response which values difference and promotes harmony and inclusiveness, not division.

By contrast, religious extremism attacks the fundamental values that we want to see binding us as a global community, which are enshrined in the UN’s Universal Declaration of Human Rights. In CAR, tackling religious extremism is fraught with difficulties. There is little state presence outside Bangui, poor infrastructure and a number of armed groups without direction that have split away from the anti-balaka/Seleka groups, as the noble Baroness, Lady Kinnock, reminded us. As my noble friend Lady Jenkin told us, children often bear the brunt of these terrible events. We have no direct evidence of the presence of any terrorist group in the country, but we are very much alive to the fact that external extremist elements will seek to exploit the conflict should it continue.

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I will deal with some of the issues raised by my noble friend Lady Berridge and the noble Lord, Lord Collins, particularly about MINUSCA and what can be done. The UK pays 6.7% of the costs of the UN peacekeeping force, MINUSCA. We contributed £23.2 million this financial year and are projecting a contribution of £33 million in the next financial year. MINUSCA’s mandate is up for renewal in April 2016. We will be working with other Security Council members to agree the new mandate. We are particularly keen to press for troop-contributing countries to rotate their troops regularly and for troops to be given training on sexual abuse prior to their deployment to CAR.

The UK has worked closely with EU partners and supported the deployment of the EU’s military advisory mission to CAR. Its purpose is to provide the Government of CAR with expert advice, with a view to reforming the military to make it into a professional army. The UK is supportive of the planning stage for a possible EU training mission to follow on from the military advisory mission, recognising that security sector reform is vital to build stability in CAR.

We are one of the largest humanitarian donors to CAR, providing £58 million since 2013 through NGOs and international organisations to support internally displaced people, including with housing, and refugees in neighbouring countries. The British Government have recently increased the UK’s commitment in 2015 by £7 million. More widely, the UK funds a wide range of conflict-prevention activity that contributes to the prevention of conflict and mass atrocities; for example, in 2015 we set up the Conflict, Stability and Security Fund, which this year provided £1 billion for conflict-prevention, stabilisation, security and peacekeeping activities. We will increase this funding from £1 billion to over £1.3 billion a year by 2019-20.

CSSF projects include work on reducing intergroup tensions; strengthening justice systems and the rule of law; security sector reform; and disarmament, demobilisation and reintegration, which I will come to in a minute. Africa was allocated £77 million from this year’s CSSF, the second largest regional allocation. Our priorities have been tackling instability in Nigeria, countering extremism in east Africa and a package of work in Somalia.

I will deal with as many questions as I can in the time available. My noble friend Lady Berridge and the noble Lord, Lord Alton, asked about MINUSCA’s effectiveness, particularly on DDR—demobilisation, disarmament and reintegration. MINUSCA is currently in the pre-DDR phase in CAR, preparing for the launch of DDR. This entails a sensitisation process and an education process for former combatants who will take part in DDR. That is essential to create the conditions for stability and security in CAR. MINUSCA is the lead on the DDR work in CAR, and it has budgeted $28 million for a DDR programme aimed at what it expects will amount to 3,500 ex-Seleka fighters in total and 1,500 to 3,500 dependants. Through the UK’s contribution to MINUSCA, we will support this vital work on pushing DDR forward in CAR. After the elections—I will come to the point made by the noble Baroness, Lady Kinnock, in a minute—the DDR programme will move forward, working with the newly elected Government.

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The noble Baroness, Lady Kinnock, and the noble Lord, Lord Collins, mentioned the elections. The noble Baroness asked whether we should delay the elections. Our position at the moment is that free, fair and inclusive elections are crucial for CAR’s future stability and to enable the country to move forward. Through the international community, we will work to ensure that an elected president appoints an inclusive government representative of CAR’s population. Some 300 extra UN troops have been provided to ensure security during the election period. I accept that there are risks and difficulties in that process. While, as a Government Whip, I am not going to make policy from the Dispatch Box, I will take those concerns back to the Foreign Office.

The noble Lord, Lord Alton, asked about local initiatives for reconciliation, especially interfaith work. The religious platform, made up of Catholic, Protestant and Muslim leaders in CAR, has been at the forefront of peace building and reconciliation efforts, engaging directly with communities that have been affected by sectarian violence. The UK welcomes the work carried out by those organisations.

My noble friend Lady Jenkin asked about preventing sexual violence. In CAR, specifically, DfID is committed to addressing the needs of vulnerable women and children and has supported several agencies to provide specialised services to victims of gender-based violence. These include the ICRC, the Common Humanitarian Fund, United Nations HCR and three NGO consortia which provide psycho-social care to survivors and endeavour to reduce the risk of gender-based violence in CAR and among CAR refugees. They also provide survivors with access to health care.

The noble Lord, Lord Alton, asked what programmes HMG are supporting to foster strong relationships among faith communities. We support a number of projects internationally, through our Human Rights and Democracy Programme Fund. For example, in Burma we have supported a number of projects. These include developing relationships between Burmese youth and different religious communities, and arranging exchanges between activists on religious freedoms in Burma and Indonesia. In Iraq we are funding a project to prevent intolerance and violence towards religious communities by strengthening the ability of youth and civil society to advocate the right to freedom of religion or belief.

My time is coming to an end and, unfortunately, that means I am not able to address my noble friend Lord Patten’s question on Syria. It is a pity but I will certainly write to him when I have taken that back to the Foreign Office.

In conclusion, this Government will be unrelenting in using the UK’s global role to tackle religious conflicts. We will employ a long-term, comprehensive approach, using our world-class diplomats, overseas aid and Armed Forces to ensure that all people are able to live free of religiously motivated and other forms of violence.

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Residential Care: Cost Cap

Motion to Take Note

3.33 pm

Moved by Baroness Wheeler

That this House takes note of the quality and viability of the residential care sector in the light of the Government’s decision to delay the implementation of the care cost cap.

Baroness Wheeler (Lab): My Lords, when I was researching for this very important debate, amid all the statistics, press coverage and reports on the cliff-edge financial state of the sector and the impact of the spending review, the one figure that most stood out showing the frightening scale of the crisis in residential care was the Care England figure of £2.16 per hour. This princely sum is the average fee paid by local authorities in England to care home providers to care for residents unable to pay for themselves. Of course, there are other ways of coming up with an average figure across the sector, but I am sure that none of them would produce a very different amount. Care England represents large and smaller scale residential care providers and, as its press release prior to the spending review put it:

“You can’t provide quality care for £2.16 an hour, no matter who you are”.

According to the Public Accounts Committee, local authorities have faced a 37% overall funding cut in real terms since 2010. They have found it impossible to raise residential care fees to try to keep pace with increasing demand and costs. Data from the residential care industry analysers, LaingBuisson, show that 1,500 care beds have been lost in England this year and that councils gave an uplift in baseline fees of just 1.9%—lower than the estimated 2.5% increase needed simply to keep pace with care home cost inflation. Out of the 166 councils providing information, 53 made no uplift in fees, and the remaining councils had either given increases below the standstill band uplifts, or fee revisions within the standstill band.

The residential care sector is home to 425,000 residents in about 18,000 homes across the UK. One-in-six residents is over 85 years-old, an age group set to double by 2035. Care home residents have a prevalence of long-term conditions, particularly dementia, stroke and diabetes-related. Many residents can have up to six co-morbidities. Some 70% of residents in the top three care home providers are publicly funded which makes them especially vulnerable to continuing pressure on council budgets. It is clear, therefore, that throughout the sector self-funders of care help to keep homes viable and in operation.

There is no underestimating the blow for people with long-term health conditions, their families and the providers of care that came from the Government’s decision in July to delay implementation of the cap on liability for care costs for four years. Some 35,000 people would have benefitted from the cap immediately. The Government's spending review repeated its commitment to introduce the cap in 2019-20, but with no money allocated. Nor was there a commitment to use fully the previously allocated £6 billion funding

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allocation for the care cap to ease the growing crisis in day-to-day social care services instead.

Prior to the spending review, there was no shortage of press coverage, providers and social care organisations pointing out the dire state of the sector to the Chancellor. There was the precarious financial state of Four Seasons Health Care—Britain’s biggest care home group providing 21,000 beds in 470 homes. It is reported to be on the brink of financial collapse, struggling with debts of £500 million. Last month it closed seven in its words “loss-making and unviable” homes in Northern Ireland. The group has a looming £26 million repayment instalment due, part of £50 million a year it has to pay to service its debts, which is it currently struggling to do.

There were also two separate joint letters to the Chancellor. The first came from the five largest providers—Bupa UK, HC One, Four Seasons, Care UK and Barchester—warning that failure to raise funding would mean that,

“thousands of older people could be left without a home”.

Secondly, a letter from 15 social care and older people’s groups, including Age UK and the Alzheimer’s Society, underlining the urgent need for more central government funding. They predicted a £2.9 billion funding gap across domiciliary and residential social care by 2020 and that,

“up to 50% of the care home market will become financially unviable and care homes will start to close their doors”.

Finally, there was the very timely ResPublica study of the private residential care sector. It warned that the funding gap specifically for older people’s residential care by 2020 would be £1.1 billion, a third of which will be the cost of the national living wage and which could mean the loss of 37,000 beds. The failure and collapse of Southern Cross two years ago affected 31,000 people. Other private providers eventually provided replacement care for them, although not without huge upset and trauma for the people involved, their carers and families.

As ResPublica points out:

“Given the perilous state of the industry, there is no private sector provider with the capacity to take in the residents who would be affected by the loss of other providers’ beds. Consequently … the worst outcome is the most likely: that the vast majority of care home residents will end up on general hospital wards”,

costing the NHS £3 billion a year.

Moreover, while public attention has been on the large-scale providers, we know that 75 % of providers are, in fact, small, local organisations—small group homes run by small teams of owners and staff or, in many of the smaller homes, just by the owners themselves. The Local Government Association estimates that, for residential and homecare contracts the national living wage will cost an additional £300 million in the first year, rising to £834 million in the second. Does the Minister acknowledge that small care homes will be the first to go to the wall if the cost of the implementation is not properly funded by central government? We applaud and welcome the introduction of the national living wage—it is vital to the future of social care, but it must be properly funded.

The spending review offers two solutions to all this, under the ironic heading “A sustainable health and social care system”. The first is to allow local authorities

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the power to raise council tax by up to 2% in their area from next year, to bring in £2 billion a year; the second is a £1.5 billion allocation from the better care fund for councils to access in two years’ time. This, we are assured in the spending review, will be enough for councils to shore up core services, increase residential care fees and pay for the implementation of the national living wage from April next year for 900,000 care workers. But how can this limited additional funding be anywhere near enough to address the scale of the problem facing us? Can the Minister explain to the House how this can possibly make the current failing social care system sustainable?

I am sure that the Minister will come back with a string of figures on the amount of money that has gone into social care, but the fact is that the detailed analysis from the LGA, the King’s Fund, the Nuffield Trust, the private, charitable and voluntary sector providers and the patient and user organisations such as Age UK, Independent Age and Carers UK all show that this is nowhere near enough. Will he undertake to provide detailed analysis of the Chancellor’s sustainability plan for social care? How much of the better care fund allocation is new money into the system, or is it just money shuffled about the system or taken from the NHS?

Earlier this week, the King’s Fund put the amount that could be raised by councils as, at most, only £800 million per year, which underlines that areas in the north, Midlands and inner London with the greatest need for social care will lose out because they will be able to raise too little income for the increase to have any impact. Care England’s response is that the 2% addition, even if raised across all councils, would not even touch the sides of the problem. The charity Independent Age has calculated that a 10% increase would be needed to plug the social care funding gap, which would of course not be locally acceptable.

Meanwhile, Four Seasons remains in a very precarious financial state. This weekend, we saw reports of the devastating consequences for families and their elderly and frail relatives in its Northern Ireland care homes, which are to be shut down with 12 weeks’ notice. Four Seasons is on course to sell 19 homes this year, which will result in their closure, and it has 12 homes under embargo and barred from taking any new residents until the quality of care improves. Can the Minister reassure the House that an impact assessment has been made, that the situation is being closely monitored and that contingency plans are in place in the event of Four Seasons’ financial collapse? Four Seasons is also selling homes to other providers, so what checks and measures are in place to ensure that the care and well-being of residents is the top priority in such sales? Does he acknowledge that this is likely to be part of a growing trend, as the smaller group homes struggle to survive?

This debate is also very much about the quality of care in care homes and the people who are cared for, their families and carers. This is the first debate focusing on the residential care sector that we have had in this House in recent years. I am most grateful that we have such a broad range of experience and insight among the speakers today, which will ensure that the full range of key issues facing the sector can be addressed,

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particularly the impact of the NHS on the rest of the sector. The ResPublica report makes a very telling comment. It says that,

“the residential care system … has been overlooked as a partner in the integration of care”,

and in developing person-centred care across the NHS and social care. Its report looks to care homes becoming the agents of early intervention and the management of chronic conditions, preventing those conditions escalating and individuals funnelling in to the acute sector, swamping A&E units and local hospitals.

The NHSFiveYear Forward View has a number of care home vanguards—the first time that the sector has had specific projects and funding—which reflect some of this thinking on trying to promote enhanced health in care homes. The projects have tight criteria for joint working and integration with the NHS and social care on care planning, residents’ health and the management of frail and elderly patients. In a number of areas, funding has been partly used to pay a higher fee to care homes so that they can focus on improving care standards and paying staff more, with new and extended job roles. This will mean that they are able to provide the care that ensures fewer residents are admitted to hospital or become permanent residents, rather than being able to go back into their homes after a short period of care following hospitalisation.

The recent CQC report on the state of care shows, as usual, the extent of the excellent care that takes place in many care homes across the country by trained, caring, dedicated nursing and care staff, as well as the reality and scale of the challenges that need to be addressed. The CQC’s five tests—that care is safe, efficient, caring, responsive and well-led—have been used for care home inspections since October last year, focusing on homes for residents aged 65 and over. Of the 300 homes inspected, 50 were rated good but 125 were deemed inadequate and 125 required improvement. Almost half of the homes—49%—were in breach of Regulation 18 on staffing, and a third—32%—fell short of Regulation 13, designed to safeguard service users from abuse and improper treatment.

Staff shortages in nursing and care staff, and the needs to attract the leadership and management which a good care home manager provides and make social care an attractive career for young people and people seeking work, underlines the importance of the national living wage. The key training gaps identified by the CQC covered the areas of dementia care, safeguarding, mental capacity and deprivation of liberty safeguards which seek to ensure that the care provider does not restrict the liberty of vulnerable residents. Social care is failing dismally to attract new and younger people into the sector. The National Care Forum’s recent survey showed that just over 11.5% of staff employed in its member organisations are under 25, while more than half are aged 45 or older. These are all issues that the national living wage, if properly funded, can begin to address.

As a carer myself, I would like to see residential care integrated much more into the care plan for people with long-term conditions living in the community, with regular respite care planned, dated and available as part of the care pathway—and as part of the

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medium and longer-term planning for the person being cared for, not seen as a last resort. Carers UK testifies to how hard it is to book respite care in care homes in advance as part of a planned package of support, because the sector has too much focus on responding to emergency care and placements and cannot give a definite yes if you want a short stay on a specific date. The answer is often “Ring us nearer the time”, which of course is no good at all.

I will end with one case study from my experience as a trustee of our local carer support charity, which sums up the current situation faced in many parts of the country. One of our 73 year-old carers had cared for her husband for four years, through stroke, incontinence and then dementia. She needed a hip replacement. He went into residential care near the couple’s home while she had the operation, but when she came out she realised she could not care for him any longer. He stayed in the care home for two years, publicly funded by the council, with our carer regularly able to visit and help with care and feeding. His incontinence problems got worse and he was catheterised, but frequently pulled the catheter off due to his dementia. District nurses could not keep visiting the home, so frequent hospitalisation took place from the care home until it said it could no longer care for his needs. He did not meet the NHS continuing care criteria and stayed in hospital for months while social services looked for a nursing home near to his wife so she could visit. Finally, he is now in a step-down bed in a nursing home, a specially fully-funded intermediate placement bed at full care home costs to free up an NHS bed. The home meets his needs and his wife can visit him regularly, but he cannot stay there and must be moved in the next few weeks to a social service placement within the council’s baseline fee. The search goes on.

Social care is in dire need of a strategic, ambitious, forward-looking strategy and vision like the NHS Five Year Forward View, which has broad cross-party support and support from stakeholders, even if there is concern and scepticism about how the future plan can be delivered in the face of the realities on the ground. Dumping on councils so that they have to raise the money and then take the blame is not a strategy. As this week’s joint letter in the Guardian from the CEOs of the King’s Fund and Nuffield Trust put it, the spending review provisions are:

“another setback for people who need social care … These are sticking plaster solutions and no substitute for adequate funding”,

that social care desperately needs now.

3.48 pm

Lord Lansley (Con): My Lords, I am grateful to have the opportunity to contribute to this debate and to thank the noble Baroness, Lady Wheeler, for initiating it. It is my privilege, not having been here for long, to hear your Lordships on this important subject.

It is important that we are discussing this two weeks after the Autumn Statement and the spending review. I am sorry that the noble Baroness, Lady Wheeler, characterised the spending review, albeit perhaps quoting others, as she did at the end of her remarks. I think that the spending review offered considerable additional

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resources over the course of this Parliament. I am frank and realistic enough to recognise, not least from conversations with directors of adult social care over the past couple of weeks, that they are sufficient at best to maintain the level of local authority-funded care in circumstances where the demand continues to rise and therefore the gap between availability and demand will grow. At worst, we will be in the situation, as we have been recently, where the availability of local authority-funded care has been falling at a point where demand is rising.

The noble Baroness’s point that there is a need for strategic vision is well taken. It is not simply a matter of resources, even though they are an integral part of the issue. Some of that strategy is being implemented and more is available to us. I pay tribute to my friend Paul Burstow who was a Minister with me in the Department of Health. In the coalition Government, we led together on the preparation of what subsequently became the Care Act. It contains a very important set of measures, including the availability of assessments, additional carers’ rights, more consistent eligibility for care and the availability of universal deferred payments.

We need to go further. Social care and healthcare need to be integrated. Everybody supports that in terms of the integration of service design and commissioning, but, vital as that is, we can and must go further. Integration will only be real if and when care users are increasingly able to exercise control and choice through personal health and social care budgets. To make that real we have increasingly to aggregate the availability of personal health and social care budgets to those care users so that the service and providers have an aggregated level of demand to be able collectively to respond and create a market for this.

We must also recognise that this will mean integrated providers with the NHS working with private sector social care providers and housing providers. There is enormous potential for housing providers and other services, particularly personal care services, to redesign the nature of the service they provide. For example, extra care housing providers together with social care providers are able to put together packages that work really well for people who are able to choose between different kinds of accommodation and service.

Time permits me to say one more thing which I think is really important. Much of what we already have in place is the product of the implementation of the Dilnot commission’s view. I hesitate because I may be stealing the thunder of the noble Lord, Lord Warner, and others in the Chamber who may have participated in equivalent work on prior commissions. I asked Andrew Dilnot and others to undertake that work and I think the result was important and right. We have included some of it in the Care Act. The Government have not implemented the cap on care costs and, to be frank, the cap that was intended was in my view insufficient. I continue to subscribe to the view that we should aim to implement a cap on care costs broadly in the way that the Dilnot commission recommended, at around £50,000 with a structure of assessment that means that probably no more than 40% of somebody’s assets would be depleted in the process of means-testing.

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The combination of these two things would make it attractive to individuals to insure against this risk in so far as they have to meet that cost, and by taking away a much more substantial part of the risk of high-cost care over a longer period of time make it a more insurable risk for private sector insurers. Additionally, since the Dilnot commission reported we have more options in relation to pension flexibilities, and we always have housing asset flexibilities to enable these insurance products to become available if it is necessary for us to have those resources come into the system.

The original intention for the implementation of Dilnot before the election was that it would be funded out of inheritance tax and changes to opting out of national insurance. That moment has gone, but in internal discussions in 2012 from my point of view we were very clear about how this ought to be paid for, but it was not acceptable inside government. There was not agreement to do it because within the system we have discrimination against residential care in favour of domiciliary care. That creates an artificial distinction that we have to escape from, which is the exemption of the main or only home for the means test on charging for domiciliary care. At any given moment, about 120,000 people benefit from that, and £1.3 billion a year is available to them by virtue of that exemption. That is broadly speaking the amount that is necessary to construct a different proposition for people who are facing the insecurity of potentially very high long-term care costs. We need to go beyond simply enabling people not to have to sell their home to pay for care and give them the security of being able to find, as you do in so many other walks of life, the opportunity to insure against the often arbitrary effects of having to receive long-term care in old age.

3.55 pm

Baroness Brinton (LD): My Lords, I suspect that given the difficulties facing the social care sector at the moment, particularly the residential care sector, much of this debate will focus on viability and financial problems, so I want to start with a comment about quality. Yesterday was the first anniversary of my mother’s death. During most of the preceding 11 years, she was at home, but she was also in respite care and residential care, and the care taken by everybody involved—the social services department, the domiciliary care company, the residential homes, one of which was a very small provider with the other part of a much bigger scheme, the hospitals and the intermediate care—was fantastic. I cannot fault any of the support and care she had from the whole of Dorset and all the people who my family were involved with over that 11-year period. It is worth pointing that out because too often we hear of the problems, and it is right that we focus on making sure that care is of high quality, but if we do so by ignoring care where it is of high quality, we miss out on many people’s experiences.

Dilnot was a very important point in Parliament’s history because the three major parties came together to agree that we needed to move forward together. Social care had for many years been something of a Cinderella issue, but the aspirations of Dilnot were certainly enshrined in some of the Care Act and I am very pleased that the noble Lord, Lord Lansley, wants

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to mark Paul Burstow’s role as Minister in making sure that much of the detail about the quality of care and the support for carers has been noted.

The problems that much of the sector faces, particularly the residential care sector, are because of the perfect storm that we now face. Much of it is financial but it is not only that. Can the Minister identify where the savings from the non-implementation of the Dilnot report have gone? The noble Lord, Lord Lansley, said that the moment when it could have been funded from other resources has gone. From looking at the spending review and some of the initial statements about next year, I understand that we are talking about probably £700 million being identifiable from that preceding amount. What has happened to it and where has it gone? It is evident that local authorities and the Department of Health are going to face major problems because of the demographics and the pressure of making sure that there are spaces available at levels that the residential system can afford if it does not have extra funding.

The better care fund, which was created by the coalition, was a step in that direction. It was a good one in that it started to change the emphasis from hospital care to residential and community care. However, despite the increase we have heard about, it is back-loaded to 2018 and 2019 and will not help over the next two years. The system is currently in major crisis. The introduction of the national living wage is also going to cause real problems for private providers of residential homes. On the announcement of the national living wage, quoted companies saw a fall in their share value. Major providers have started disposing of large numbers of homes, because they are seriously worried about how they can trade, let alone make a profit. Finally, lenders to that sector have stopped lending, because the business model is bust. If that is the case, everything that the Government are trying to do through the better care fund will be useless. More and more people will be staying in hospital because there will not be the beds for them to go to.

The local authority social care directors estimate that the current local authority shortfall will be £4.3 billion by the end of this Parliament. It is not clear from the spending review that there will be enough to fund the national living wage or demography. We know that cumulative local authority budgets have been cut over recent years, but what is less well known is the result for those authorities with social care responsibility: five years ago 30% of their funding went on social care, while it is now 35% and increasing. As a result, they have had to face tightening eligibility thresholds quite substantially, so that now only those with the most severe need can get any help at all, forcing pressure back on the primary care sector and on hospital trusts.

Members who have been involved in these debates will know that earlier in the year I spoke about one poor pensioner in the north of England who was told quite clearly that one of her legs was social care and one of her legs was her GP. She ended up going back into hospital because the social care element was not able to maintain one of the legs. This resulted in an emergency bed because the primary care would not let

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the nurse look after the leg with the other problem because it was not its leg. That story is easy to laugh at, but when budgets are so tight and protected, it makes people behave in peculiar ways. We have to find ways around this problem.

I have another concern. Some care providers have been told by their local authorities that they should fund the basics, like sick pay and travel between work for those in the domiciliary sector, from the profits they make from self-funders—and that they should not be expected to carry that burden for either health or local authority-funded patients. This is unbelievably facile. We need to make sure that we understand the cost of funding a residential care place. If our public sector is asked to provide it—which it must be for those in need—the funds must be available.

Of course, the demography is increasing so even without the pressure that we are seeing the situation will undoubtedly get worse. In the last few seconds, therefore, I would like to talk about a parallel. If the pressure that we are seeing in this sector was evident to people on the nightly news in the way that we have seen flooding in the last few weeks, I suspect that the Treasury would act all too quickly in making sure that emergency funds were available.

In closing, I repeat my question to the Minister. At the very least, please can we be assured that the money that should have gone into Dilnot is passed straight through to the sector this year, not just some of it during this Parliament?

4.03 pm

Lord Turnberg (Lab): My Lords, I, too, am grateful to my noble friend Lady Wheeler for introducing this debate and pointing out so clearly all the difficulties we face. It is difficult not to be gloomy and I am afraid I shall not lift the gloom. Way back in 2011, we had a harbinger of what might happen to care homes when Southern Cross failed with the loss of a large number of beds. Local authorities, which are mandated to care for their needy citizens, were left to pick up the problems; they cannot refuse to do so. Now we are starting to see more of the same, as other large providers of care homes get into difficulties. The latest is Four Seasons, as we have heard, which finds that offering this type of care is increasingly non-viable financially. As my noble friend Lady Wheeler said, it is already in considerable debt, as has been laid out in stark terms in the Financial Times. We could see the loss of many more beds and Four Seasons is unlikely to be the only one so affected.

It is not difficult to see how we have got into this situation. Government funding for local authorities has been severely squeezed and the impact is clear. Since 2010 there has been a fall of 25% in the number of people receiving social care, and the fees that care homes receive from local authorities are strictly constrained. To add to their problems, they are now faced with having to pay their staff the new living wage. Quite right, so they should—these staff have been disgracefully underpaid for the critically important work that they do—but it will cost the sector some £2.3 billion over the next four years. The net result is that care home providers are hit with the double whammy of increased costs and limited income. It is

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little wonder that they cannot break even. Private domiciliary care providers such as Allied Health have found themselves having to face up to the extra costs due to an EU directive obliging them to pay for journey times to and from domiciliary visits, when hitherto they have been able to get away with it.

It is not only on the supply side that there are difficulties; the demand side is difficult, too. Since 2009-10, the over-75s have increased by about 500,000, a 9.5% increase. It is not simply the increase in numbers that is problematic; the elderly are living longer with disabilities. It does not help to know that in the UK the time between the onset of disability and death is now seven years. That is seven years of dependency. That compares very unfavourably with Norway, where people suffer only two years in need of support before they die.

Of course, many of the causes of dependency lie outside the remit of the Department of Health, but public health clearly does not. While lip service is paid to prevention in all the health plans that one reads about, it is sad to discover that funding for public health is to be cut—by something like £800,000, I am told. That seems an extraordinary thing to be doing when we are trying to reduce the burden of disease. I well understand that it would be difficult for the Minister to change Treasury plans, but is there anything he can do to suggest that it would mitigate the impact on public health?

All this is leaving local authorities and hospital services to pick up the tab, and neither is in a good position to do so. The fall in government support for local authorities is supposed to be bridged by permission to increase their council tax by an extra 2% a year, over the 2% that they already have the flexibility to raise, for the next four years. However, to raise a total of 4% a year across the country consistently for several years is a difficult ask, and it will be much more difficult in poorer areas of the country.

As we have heard, they will have access to the better care fund, money transferred across from the NHS, but they will not receive much, if any, for the next two years. By 2021 they will get about £1.5 billion, and it is interesting that this transfer just about matches the extra that the NHS is due to get. So there is not much relief for the next two years. Local authorities will inevitably have to raid other budgets—but they will already have been doing so for some time, and there is little slack left in the system.

I did not want to talk about the hospital sector in this debate, but it is hard not to when we know that some 30% of beds are occupied by patients who do not need to be there. Everyone knows that. If nursing homes start closing, more patients will be admitted unnecessarily to a place quite unsuited to their needs, and there they will stay for far too long. It is certainly true that the NHS received a very welcome boost in the recent CSR. We should not look this gift horse in the mouth as it is sorely needed, but I fear that it will be only a temporary relief. As the noble Lord, Lord Lansley, said, we desperately need a more basic change in the way that we provide health and social care. It seems inevitable that we will move much more rapidly to a joined-up health and social care system, the fully

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integrated service that is talked about so glibly. I am not sure that it will be necessarily save money—indeed, it may even cost more to get it off the ground—but that must be the way to go for the patients.

Here and there across the country, efforts are being made by innovative and dedicated managers to do just that, but they are having to operate against the grain of the bureaucracy that we have set up centrally. What progress has been made since David Dalton’s report to smooth the path to integration by government, and can we expect a more rapid uptake locally? It will not solve all the problems we face—I fear that more funding for social care by one means or another will inevitably be required—but it will go some way to improving the care of a large number of our most vulnerable people who are currently being shipped around or, even worse, being neglected completely.

4.10 pm

Lord Filkin (Non-Afl): My Lords, I declare an interest as chair of the Centre for Ageing Better, a new What Works centre promoted by the Government and well-endowed by the Big Lottery Fund but with full independence from both. I thank both for their wisdom in promoting it. The centre seeks to seize the benefits of the longer lives of more older people, so that we all benefit from that.

Some noble Lords will remember that two years ago this House produced a report, Ready for Ageing?, which set out the enormous opportunities of longer lives. It also made very clear that both individuals and the Government had to change to avoid a series of miserable crises—to quote roughly from it. I fear that what we said then has come to pass and we are now in the midst of a miserable crisis on social care, which I fear will only get worse.

Most of this debate will be spent talking about the immediate crisis. I am not going to do that; it has been well covered by other noble Lords. I will suggest instead that it is essential to look forward five or 10 years in public policy and public debate. The number of people aged over 85 will have increased by 17% by the end of this Parliament. In 10 years’ time, it will have increased by 40%. This is a social revolution and it matters because most formal social care is focused on those aged over 85. Another National Audit Office figure shows that 50% of those aged over 85 require some form of social care. We have clear evidence of rapidly rising demand and have experienced some of it over the past few years.

The Commission on the Future of Health and Social Care said:

“The government appears … to have no strategy whatever to tackle the rising and pressing needs for social care”.

I regretfully agree. This matters massively. We are talking about our oldest old in society and how they are treated with decency. We are talking about very fundamental things—help to get out of bed in the morning, help to wash or to bath and help to put on shoes and socks, let alone other forms of care. It is not some abstract debate about public policy.

What is needed by all of us—the Government as well—to address this? There is not time in seven minutes to give more than a very crude agenda, which

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most noble Lords know already. We clearly know that people wish to sustain their independence for as long as possible; therefore there is a serious question about what needs to be done and what works to sustain an individual’s independence. We all know we have to grow and support informal care. It is the foundation of care in our society and I am glad the Government are making progress on how to support carers more. We also have to use the asset of more older people and community action to address how to support more frail and ill older people. This will deal only with lower levels of need. You cannot expect some of the really heavy lifting to be done by individuals and volunteers.

That takes us to the fundamental question about what sort of supply of care we need to cope with the certain rapidly increasing demand we face. It is obvious that we need more home care because it is fundamental to making the system work well. We will need more residential care—that is a starting point. ResPublica estimates that 15% more residential care will be needed within five years. Even if it is wrong by three percentage points, it is a significant increase. We need, above all, a much bigger and more skilled care workforce to cope with more residential, domiciliary and palliative care.

Yet the consequence of local authorities, which dominate the market, being starved of funding is that we are driving down supply and weakening the ability to build a workforce for the future. There is not much sign anywhere that anybody has a strategy either for workforce and skills growth or for generating the mixed supply of domiciliary and residential care that our public will need as we go forward. That is staggering and horrific.

I shall give your Lordships one piece of evidence that shows why the care market is going south when it should be going north. Professor Martin Green, the chief executive of Care England, wrote to me this week. He said that Care England, which represents carers across all sectors, is now recommending to care providers that they should try to withdraw from the publicly funded provision of social care. That is on-the-record advice, and noble Lords already know why it has been given. It is a shocking situation.

I would like to ask why we are where we are. None of what I have said is news to good officials in the Department of Health, and it is not news to a good, thoughtful and well-informed Minister. What I have said is all known but we are not seeing action—for two reasons. One was set out very well by the noble Baroness, Lady Brinton, and it relates to the hidden misery. Hundreds of thousands of people are suffering in invisible places and, unlike the NHS, they do not have political salience. The second reason—I am not being party-political; your Lordships can see where I now speak from—is that the Ministers in the Department of Health are trapped within the Government’s fiscal and political stance. I do not deny the importance of fiscal balance but it is clearly possible to achieve fiscal balance and better care at the same time if you apply your mind to it and if you give bold political leadership. Fiscal balance is necessary but we also have to grow a market and a workforce to cope with social care.

As I get towards the end of my remarks, I ask your Lordships to consider the irony of a political stance—which many of us understand—that involves seeking

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to protect pensioners in a very privileged way in relation to tax and benefits. That is what has happened in our society and it is the stance of the current Government. Yet, at the same time, the Government are withdrawing funding, which means that now—and the situation will become even more serious over the next five to 10 years—hundreds of thousands of pensioners will be deprived of the support that they will desperately need in order to live in circumstances where there is respect and decency.

Trivialising matters slightly, we should ask whether many of our older people would be prepared to trade some of the highly privileged tax and welfare benefits that they now get so that they and others who are older can benefit from the required levels of support and decency. A strategy will be required, as well as consistent public funding, to ensure that those in the greatest need are properly cared for. That will require a much more grown-up debate than I have seen any sign of yet on how our welfare settlement needs to adjust in order to cope with the many more older people who will have the opportunity to live longer lives. We are obviously not facing up to the changes that we need to make in public policy but it is urgent that we do so.

4.18 pm

The Lord Bishop of Bristol: My Lords, I join other Members of your Lordships’ House in thanking the noble Baroness for securing this debate. I admired her high-paced delivery of a lot of information without losing any clarity. Like the noble Baroness, I hope that this will not become a debate where we just trade statistics across the House, because in the end, as the noble Lord, Lord Filkin, has just drawn our attention to, this is about people and their lives, and therefore it is a matter that should be, and is, of great concern to us all.

If I stand in my bathroom and look out across the fields in north Bristol, I see the shell of Winterbourne View standing there as a testimony of what can go wrong with residential care when the business model is bust and the whole thing falls apart. It pains me to look at that building day by day.

Your Lordships have made it very clear, through the competence of this debate, that we have to do better. Just this morning when I turned on my radio, I heard that the Nuffield Trust is saying there is going to be a massive crisis this winter in the National Health Service, because a lot of people who are in hospital really should be in residential care but there is no space for them. We all know well—certainly, your Lordships know well—that we have an ageing population. More people now live in single-occupancy homes. People are often, sadly, estranged from or live a long way away from their families. Although I agree with the comments made this afternoon about complementary domiciliary care, we are here to talk about residential care and what that might look like going forward.

The chairman of the Commission on Residential Care, Paul Burstow, having noted, as the noble Baroness, Lady Brinton, said, that there are some very good examples of care, said:

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“There are some tough messages. The brand of residential care is fatally damaged. Unloved, even feared, for most people residential care is not a positive choice. Linked in the public mind to a loss of independence, residential care is seen as a place of last resort.”

We heard from the noble Baroness, Lady Wheeler, about the Care Quality Commission’s evidence. We have heard about ResPublica, which has revealed the devastating fact that 37,000 beds will be lost between now and 2020.

I remember, back in the 1990s, when I was more closely allied to investment institutions, there was quite a move for investment institutions to invest in residential care. If I recall rightly, even the Church Commissioners looked at that. Now, we seem to be in a very different place. We have heard about Southern Cross, and about Four Seasons. I know the Minister will be concerned about this issue, but to my mind it does create a massive void in terms of how we are going to deal with it. I am not clear, as yet, from what I have heard from the spending review, that the plan thus far will be able to fill that void.

I am most grateful to the noble Baroness, Lady Brinton, and to the noble Lord, Lord Lansley, for mentioning Dilnot. The Dilnot report was a very important piece of work which I hope will not get lost. I hope the Minister will feel able to comment on exactly where we go with that.

There is a lot of anxiety, especially about documented failures in the care system. I think it was Oscar Wilde who said that biography lends terror to death. One might slightly bastardise his comment and say that residential care lends a bit of terror to those who know or feel that they might need residential care going forward. We have had Winterbourne View and Hadleigh House in Lincolnshire, and we heard the Minister this morning repeat a Statement about the terrible abdication of care in Southern Health NHS Foundation Trust. I welcome the fact that the Government and the NHS are now placing a renewed emphasis on palliative care and end-of-life services, but can the Minister assure us that it is equally essential that the priority being given to end-of-life services be applied adequately to residential care?

There is anxiety about this whole issue. Let me end where I started, by reminding your Lordships, as several noble Lords have reminded the House, that in the end this is about people. It is about the kind of care they might get, and how we face the cost of that. It is a particular anxiety, I guess, for those people who do not have what are called fat pensions or easily realisable assets to pay for their care—in other words, some of the poorest people in our land. The question remains for me: who will care for these vulnerable people when they can no longer look after themselves? We are facing a huge problem and I look forward greatly to hearing the Minister’s response to many of the questions raised by noble Lords.

4.25 pm

Baroness Redfern (Con): My Lords, I, too, join other noble Lords in congratulating the noble Baroness, Lady Wheeler, on introducing this very important debate this afternoon.

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I know all too well, through my own local authority in North Lincolnshire, the pressures the sector faces, both locally and nationally, in providing high-quality and affordable residential care. As Members of this House are aware, the first stage of the Care Act 2014 came into force last year, providing a single, modern statute that puts an individual at the centre of their own care. The introduction of a cap on care costs is welcomed by many. However, without going over ground already covered this afternoon, concerns were raised regarding the cost to public sector spending of a cap.

As a result, Her Majesty’s Government announced in July that there would be a delay until April 2020, particularly to allow further consideration on the implementation and sustainability of what will perhaps be the biggest reform of the payment of care since 1948. I strongly believe that Her Majesty’s Government wholeheartedly support reforms to assist those requiring care, and I look forward to further announcements on this.

That said, let me turn to my authority and add an important local dimension to this debate. As a local authority we have looked at the best way to implement these reforms to care and support under the new rules of the Care Act 2014. We put people at the heart of what we do and constantly work from that position to help those in need. We work hard to ensure that they remain safe and properly supported. We want to work with those who receive care and, importantly, their families to transform their lives for the better.

I am pleased to inform your Lordship’s House that North Lincolnshire continues to be a high-performing authority and we continue to develop and enhance a vast range of care and support services to meet local needs. Although the changes to the Care Act aim to give greater choice and control to those in need of support, we found that we are already fulfilling some of these duties. We said that we would increase the number of vulnerable people helped to live and receive care in the community, and we achieved this through a number of different routes.

First, we did this by increasing the accessibility to advice and information at the time of choosing a care package. We also carry out regular reviews to check progress with the individual’s care. Access to information of services is incredibly important, and the adult social care outcomes framework measured the percentage of people who found this information about services in North Lincolnshire increased from 77.4% in 2013-14 to 84.4% this year—the joint highest result in England.

Secondly, we established community well-being hubs, which offer access to services for those with more complex care and support needs, helping individuals to identify ways to improve their independence and well-being. I am pleased to say that we now have five of these hubs across North Lincolnshire as well the Sir John Mason intermediate care centre in Winterton, which I mentioned in my maiden speech such is our belief in the excellent facilities on offer there.

By working closely with health colleagues and other organisations, more people are being supported to remain living well—that is really important—for longer in their own homes and community. A great focus has

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rightly been placed on adult carers, with an increase in the number supported than in previous years. The noble Lord, Lord Lansley, earlier alluded to working with partners to increase the provision of suitable and adapted housing for people with complex needs. More people than in 2013-14 now have control of their own support, through a direct payment which is personal to the individual’s need. A personal budget gives people control to choose how, where and when they will be supported.

Our ultimate intention is to ensure that everyone living in a care home receives good and outstanding services across the area, and we want to work with them to achieve this. We also said that we would increase the number of vulnerable people who have real choice over their care and the support they receive. By undertaking personal assessments, again we support people to remain independent, and we make sure we personalise the approach to their care. Independent living is, I am sure, something that noble Lords would agree that many of us at times take for granted.

Furthermore, I cannot stress enough the significance of the relationships social work teams must have with individuals, their families and carers in order to understand their care and support needs, and how they would like these needs to be met. The better care fund, introduced more than two years ago, creates a single shared budget, which encourages the council and NHS to work together.

The priorities of the partnership agreement were to reduce hospital admissions, lengths of stay in hospital, delays in transfers of care from hospital and also permanent moves into care homes. To end, North Lincolnshire’s social work teams continue to ensure that people are at the heart of what we do. I hope that other local authorities, too, welcomed the reforms to the residential care sector and that they had as much success in implementing them. As we have discussed, for the first time in nearly 70 years we are presented with an opportunity to undertake a proper review of residential care. I welcome Her Majesty’s Government giving proper consideration to designing a means to support and protect vulnerable people from potentially catastrophic care costs, both in North Lincolnshire and across the country.

4.31 pm

Lord Lipsey (Lab):My Lords, I declare my interest as unremunerated president of SOLLA—the Society of Later Life Advisers. I do not know how many noble Lords had a chance to catch the serialisation of the new book, Alive, Alive Oh!, by the inspirational Diana Athill, on Radio 4 this week. Diana Athill is someone who chose to go into residential care and has never regretted that decision. There is a strong tendency, in my experience, to think of residential care as a second best—what you fall back on when you can no longer safely stay in your own home, or your relatives cannot or will not support you. That lay behind Gordon Brown’s infamous plan to make care free at home while it was still charged for in residential homes. However, that view of the world ignores the loneliness, discomfort and lack of physical support that so many old people struggling on at home experience, whereas good residential homes—the CQC rates three in five

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as good or outstanding—provide many things that old people such as Ms Athill value: company, comfort, care and community activities.

The puzzle for me is why more people do not opt for residential care. Fear of the unknown is, I am sure, part of the answer. But a major factor is cost. People worry that if they go into a home, the assets they hoped to leave to their children will be denuded. That is why there was almost universal support for the Dilnot report, which advocated making the means test less onerous and capping care costs. That support included the party of government, the Conservative Party. Its manifesto said:

“We will cap charges for residential social care from April 2016”.

That was the election manifesto that the people endorsed in May, and which was torn up by the Government in July. They sneaked out, on a Friday afternoon, an announcement postponing the cap until 2020. They reneged on their pledge once; can anyone in this House be confident that they will not renege again come 2020, when there are so many attractive things that they can spend money on to buy another election victory?

The Government sought to blame local authorities for this delay. It is true that local authorities were very concerned and had difficulty implementing the cap—for one reason only: the Government were setting onerous conditions on how they should implement it, without providing them with a fraction of the money that they needed to put it in place. Personally, and as an old defender of local government, one of the things that I do not like about this Government—I do not dislike everything about them—is a strong tendency to blame local authorities for things that have come about simply because central government has denied them the funding that they need.

The postponement of the cap was not the only thing that the Government did. They smuggled out the abandonment of another Dilnot proposal even more surreptitiously so that no newspaper to do this day has noticed it—a proposal that is even more important and desirable than the cap. That was the raising of the cap for the means test. At the moment, you start to get some state assistance at £23,250; you get all your care paid for when you have only £14,000 left. Dilnot recommended raising that to £118,000. Before the election the Government said, “Yes, we’ll do that”, and after it said, “No, we won’t”. People who have worked hard all their lives have the prospect of seeing their wealth evaporate as they sit in residential homes. No wonder not many want to go into one.

The Government did that, but they did not drop the taxes that they imposed to pay for it. To take one, they froze the inheritance tax threshold for three years to get the costs. That raised £690 million over three years. We do not have that back now that it is not being spent on this subject; they have kept it. I have heard of stealth taxes and of death taxes, but this is the first example in human history of a stealth death tax.

Finally, we have heard a lot in this debate about underfunding. I agree that those of us who attack cuts are often guilty of not saying how the cuts that we do not want to make will be paid for. I have one suggestion

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where substantial sums can be raised in this field and used to improve the quality of care. I do so with a clear conscience because it is a piece of government spending amounting to about £500 million a year, for which I was very largely responsible. When I was part of the minority report of the Royal Commission on Long-Term Care of the Elderly—its distinguished chairman will speak to the House later—we wanted to go some way to meet the belief of the majority in free care for all. We therefore suggested that nursing care should be free for those who need it—strictly nursing care. There was a logic to that because nursing care is very like what you get in the National Health Service for free.

As I have gone on, in view of the shortage of resources I think that this was a rather unwise suggestion. Almost all the money involved goes to people who are rather well off; it is not like the means-tested money that goes to people who are less well off. It is indiscriminate and mostly helps the rich. So far as I can find out, because it is paid to care homes, very few people know that they are getting it anyway. If it were abolished—not for existing recipients, of course, but for new ones—the Government would save in excess of £500 million a year, which could be used to up care home fees, make them more viable and make the standards that they provide better for all our older people.

4.38 pm

Baroness Pitkeathley (Lab): My Lords, I thank my noble friend for the opportunity to debate this important issue and congratulate her on her timing, in a week when so many relevant reports are being published.

Your Lordships will know that it has become axiomatic to say that social care is in crisis. The situation faced by care homes is an integral part of that, but I must first acknowledge the improvements in the care provided in care homes since I was first involved in this issue more than 40 years ago. We have moved a million miles away from the old pattern of local authorities providing a very low level of care, to a mixed economy of mostly private and voluntary care home owners commissioned to provide care by local authorities. Our standards are now higher. Single rooms with en-suites were unheard of in the 1980s. Now they are of a standard to which everyone aspires, although sadly, financial pressure is now leading to concerns about the quality of the care.

While we must acknowledge improvements, we cannot turn away from the problems faced by the care home sector. It is proving more and more unstable as cuts to local authority budgets bite and financial pressures lead to concerns about the quality of care and the amount of care available in the future. The delayed implementation of Part 2 of the Care Act, the new means-test levels and the increased pressure on local authorities to arrange care at the request of self-funders all contribute to the crisis. I, like other noble Lords, would like to know what has happened to the saving the Government accrued by not implementing the care cap. I am sure the Minister will tell us that. It was to be hoped that following the Autumn Statement, we might have been more optimistic but there is widespread agreement among care home providers and others that the Chancellor missed an opportunity. Indeed, it has

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been called another setback for social care. Of course, the major review announced by the Chancellor into integrating health and social care by 2020 is welcome, although I would be more hopeful of this if it were not the umpteenth time I have heard such a pledge over my lifetime. Indeed, in the 18 years I have been in your Lordships’ House, I do not think there has been a year when we have not had a debate—sometimes I have been sandwiched between the noble Lords, Lord Lipsey and Lord Warner, as I am today—in which better integration of health and social care was called for and promised. We are still waiting.

Councils, as we have heard, will be able to raise council tax by up to 2% to fund adult care, but not every council will be able to levy this much as their cost bases are so different and it will not be uniform across the country in any case. If every council raised it by the full 2%, this would only raise about £800 million—a fraction of the shortfall of £2.9 billion. And we still have a major problem with the relative clout of health and social care, as the noble Baroness, Lady Brinton, has reminded us. We tend to focus on hospitals and healthcare, while social care in any form is seen as a poor relation. It is news if hospitals are under pressure, much less so if local authorities are, and even less if care homes are. I, too, want the crisis in social care and the care home sector to be given as many column inches as the floods have been given this past week.

Undoubtedly, care homes will begin to close when the national living wage is introduced in April. No one disputes that this is the right thing to do but we have to recognise the strain it will put on care homes, especially the small operators. One group of providers estimates that it will cost £10 million to put their 14,000 employees on the national living wage. Care homes which provide for self-funders will no doubt put their fees up to accommodate this, but those who depend on state-funded residents have already suffered a real-terms cut of 5% in fees over the past five years. Even if councils do manage to raise more via council tax and raise fees accordingly, I fear that many homes will shut.

Nor should we confine our concerns to the private home care sector. Thousands of people in residential care are provided for through the voluntary sector, and these homes are often preferred by residents for the understanding they bring to particular conditions or particular ethnic groups. Many voluntary organisations have in fact been subsidising the care home sector for years. Financial pressures are now catching up with these organisations too as their fundraising becomes more difficult and local authority support is being withdrawn. Naturally, this will be of great concern to family carers. For many, care homes are a last resort, contemplated only when the carer is absolutely at the end of his or her tether, often after years and years of coping alone or with minimal support. I remind your Lordships that the latest assessment of what carers save the nation is £132 billion a year—the cost of another complete health service.

Sometimes, having a care home available in the background or to provide respite care, if only for a weekend or the odd week once a year, enables the carer to continue. Therefore, carers’ needs must be factored

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in when we contemplate the future of the care home sector. Even when the cared-for person is eventually admitted to the care home, the family carer often visits every day and spends many hours seeing to the needs of their loved one, becoming part of the care team.

Good care that meets the needs of the person being looked after can improve a carer’s ability to cope for longer periods. If care is poor, it can have a huge and damaging effect on carers as well as residents—not only directly on the amount of care they have to provide themselves, but on their emotional and physical health and their finances. If residential care becomes a less viable option in certain areas, the consequences are stark for families as well as for those in need of care.

We have concentrated today on the problems faced by the care home sector. Many will be solved by more money but we really need—as so many of us have been saying for so many years—a five-year plan for social care as far reaching as the one for the NHS: a fully integrated service with budgets and services that are not differentiated. That would be possible if the will was there but, sadly, there is no sign of this so far. I am sorry to sound cynical. I hope the Minister can convince me otherwise.

4.46 pm

Lord Warner (Non-Afl): My Lords, like others, I congratulate the noble Baroness on securing this timely and important debate and on her excellent analysis. I declare an interest as a member of the Dilnot commission and I am grateful for the kind remarks made about our report in this debate. I am, naturally, disappointed that the Government have chosen to postpone until April 2020 the implementation of our proposals, which were set out in Part 2 of the Care Act 2014.

I start by asking the Minister: what happened in the spending review to the £6 billion set aside for implementation of the Care Act? As far as I can see, only about £700 million has found its way into the social care budgets.

I shall focus on the sheer unsustainability of all publicly funded social care on the path we are now set upon. This is a totally avoidable man-made crisis which has been going on for a long time. We set out in our report that social care funding going back to the 1990s—this has gone on under successive Governments—has not kept pace with the NHS, despite the fact that it was dealing with the same demographics. We said it was underfunded in 2010 by £1 billion and that things had to change. They certainly did—they got worse. Then, up to 2014-15, another £2.5 billion disappears from the social care budget. A Parliamentary Answer to me on 24 November this year by the Minister shows adult social care spending dropping from £17.19 billion in 2010-11 to £15.51 billion in 2014-15, in constant prices and with NHS transfers included. We can debate the precise figures but before we start the next financial year, there is a black hole something north of £3 billion in social care budgets for publicly funded social care. That will get worse with the arrival of the national living wage, which I support, which is estimated to cost more than £300 million in 2016-17 and more than £800 million a year by 2019-20.

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What have the Government done in the spending review in response to this financial conundrum? They have promised an increase in the better care fund of about £1.5 billion. However, the small print suggests that little of this money will arrive before 2018-19. As others have said, councils will have the power to raise council tax by 2% a year from next April without a referendum. That is a great idea. However, the Institute for Fiscal Studies suggests that, even after four years, the best that will have done is to get the annual increase up to somewhere approaching £1 billion.

We also have to accept, as the Institute for Fiscal Studies has pointed out, that there will be enormous geographical variation in the way that precept is applied and in the amount of money it will produce. Will there be any smoothing mechanisms after April 2016 regarding these precepts?

Of course, councils could cut other services to fund adult social care, but they have already put £2.5 billion into social care from this source since 2010 and the departmental expenditure limit for local government is to be cut by a further—wait for it—56% by 2019-20. The Government seem to be betting the farm on local retention of business rates to plug the gap, but we will not know how much this will produce until a consultation on retention is undertaken. It looks to me as if the funding hole in adult social care gets worse and worse in the next two years.

The results of this continuing funding failure are that eligibility criteria continue to be tightened, payments to service providers shrink further and standards of services decline, sometimes dangerously. Some 400,000 people have already left local authority-brokered care over the last four to five years. Self-funders in care homes are now subsidising publicly funded residents in the same homes by up to 40% more than councils are willing to pay. Another recent parliamentary Answer to me by the Minister shows the number of registered residential care homes declining by about 1,100 to just over 17,000 between April 2010 and April 2015. Occupancy is dropping in many homes, and some sources say there are around 60,000 empty care home beds. There are plenty of beds—just no money to buy their use.

Providers are leaving the sector or concentrating on self-funders only, or on higher quality and higher-price offers. The financing models and backing of some big providers now look very fragile. You need do no more than read the financial pages to see this. There is no capacity in the system to cope with another Southern Cross failure. Will the Minister say whether these problems in the care home sector feature in the Department of Health’s risk register?

I do not have time to say much about the knock-on effect on the NHS. Some 20,000 people are now almost a permanent stock awaiting hospital discharge, and the figure can only get worse. If there is a collapse in the residential care home sector, the NHS becomes the carer of last resort. That is an inevitable consequence, and that is not the only factor for the NHS. This will eat up a lot of the resources that the Chancellor has already put, or has promised to put, into the NHS and it will knock Simon Stevens’ five-year forward view seriously off course.

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Near where I live, a rather beautiful Georgian house recently collapsed because the misguided owner had hollowed it out so much. The collapse has put in jeopardy the survival of the next-door neighbour. This strikes me as a rather good analogy for what is happening to adult social care.

4.53 pm

Lord Bhattacharyya (Lab): My Lords, I also thank my noble friend Lady Wheeler for securing this debate. When two years ago the Government committed themselves to capping the cost of care, the Health Secretary said that the policy would create,

“certainty, fairness and peace of mind”.—[

Official Report

, Commons, 11/2/13; col. 592.]

Both the summer postponement of the cap and our debate today demonstrate that those pledges are just a distant hope. True, the challenges the Government faced were vast. Social care was an unreformed, unsustainable system. For some, social care meant losing all their savings. For others, it meant inadequate homes, or worse. A growing number were denied support altogether.

The Care Act was a serious attempt to address these issues. It was not perfect but it put a limit on financial risk and set clear guidelines. However, five years after Dilnot, we find that 400,000 fewer people now receive social care and 1 million more elderly people have unmet needs. Care home providers warn of bed reductions and home closures. The only place where the cost of care has been capped seems to be the spending review. After all, we know that the cost of care is growing for those in need. The threshold at which you must pay the full cost of your care has now been frozen for five years. This care creep means that more and more pensioners are losing the right to any help with social care every year. Those who still qualify for some support have seen their bills increase by almost 50% since 2010.

We know that pressure is growing for carers. Since the turn of the century, 1 million more people have become unpaid carers. The number of carers doing 20 hours of unpaid work each week is up by over a third. The LSE estimates that a third of a million carers have left the workforce altogether.

We know that the burden of care is falling on our health service. Cancellations of urgent operations in the NHS have almost doubled in just two years. The reason? Patients cannot leave hospital if there is no care at home. Just last week NICE told hospitals to appoint a discharge co-ordinator to try to get patients out of NHS beds. That is money being spent in the NHS to deal with the care cuts.

We have heard the Government’s response to these growing stresses in the system. They say that councils can increase taxes, which is welcome, of course. However, you cannot fund national social care fairly with a system that allows Wokingham to raise twice as much per head as Birmingham. Next, the better care fund is being increased—but only in two years’ time. We shall wait and see. Finally, the care cap is being delayed, as many people have said, saving £6 billion. The truth is that the savings from delaying the cap will come from the assets of those in care. With no care cap, more

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family homes will become deferred payments for social care. Self-funders will still get no support for five years, even if eligible for help.

I accept that there are no easy answers. Many of these issues dogged the last Labour Government as well. Nor do I think you can build a strong social care system on the basis of unsustainable borrowing. Ultimately, if we want decent social care, we must pay for it. I will highlight two ways in which we could do so. First, it is bizarre that while we are making huge cuts to social care, we are increasing pensions via the triple lock. The Government’s actuaries say that the triple lock already costs an extra £6 billion a year. That is the same as the care cap. Politically, the triple lock may seem untouchable. But if those excess pension rises were used to fund social care, we would be changing only how we help our older citizens.

For a longer-term solution, we must examine the broader pensions and tax system. One consequence of delaying the care cap is that for the next five years anyone who withdraws their pension faces the risk that their nest-egg will be snatched to pay for social care. This could be the next pensions scandal. However, it also suggests an opportunity. The Government are reviewing the tax arrangements for pensions. If pension funds are to be truly flexible, surely we can encourage savers to use these savings to support their care needs. Why not make using your pension to pay for social care tax-free? To help create a save-for-care culture, we could offer younger people “care ISAs”. We could even cut tax-free allowances for the wealthy to fund incentives for people on lower incomes to save.

Finally, the Government have hinted that they might move to a “tax first, exempt later” pensions policy. This would give an immediate, if temporary, increase in tax revenue. It would make sense to use such a windfall to fund a transition to an integrated health and care service. I would be interested to hear from the Minister if such approaches are being considered in the pensions review. Clearly, finding money in an austere age requires creativity but, as my noble friend Lady Wheeler made so clear, social care desperately needs resources. Last year we agreed on the right ends; this year our ambition must be matched by means.

5 pm

Lord Bichard (CB): My Lords, I declare an interest as chair of the Social Care Institute for Excellence and as a vice-president of the Local Government Association. I want to begin, as others did, by thanking the noble Baroness, Lady Wheeler, for giving us the opportunity to have this debate. It is not only timely; many of us probably feel that it is long overdue.

I hope my new-found friend on these Benches, the noble Lord, Lord Filkin, will not be upset if I say I shall try to avoid using words such as “crises”, “disasters” and “catastrophes”, though it will not be easy on this occasion. For many of us, the condition of the care sector in this country is one of the most pressing and serious issues facing us at the moment. It has increasingly serious consequences, especially for older people with limited means. As other noble Lords have said, this is a people issue. My worry, quite simply, is that the Government appear not yet to have a convincing strategy for resolving the issue.

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Others, not least the noble Baroness, Lady Brinton, have referred to the perfect storm facing the sector. The living wage—necessary though it is to raise the status of care workers—will impact on the economics of care provision. Those now in residential care tend to have multiple, complex conditions which require intensive support. The huge reductions in local authority budgets cut the number of those in receipt of adult social care by 28% between 2008-09 and 2013-14 and forced local authorities to drive down the price they were able to pay providers. What is not yet fully grasped by the great British public is that those who can afford to pay are now subsidising those who cannot. Self-funders are now paying an average premium of 40% for their care.

For all the rhetoric, the vanguards, the pioneers and the ring-fenced budgets, there is still insufficient integration of health and social care around the client. The noble Baroness, Lady Brinton, gave the example of legs. I think she will also remember the example of an assisted bath; is it a social care assisted bath, or is it a health assisted bath? How did we get into this situation?

The CQC has warned that a third of care providers require improvement, while the five largest providers have warned of significant failure in the next two years. These are the facts that have shaped the current reality. It is a reality highlighted recently by the latest survey carried out by LaingBuisson which shows that, for the first time since 1990, in the six months to March, more older people’s care beds have closed than have opened, with a net loss of 3,000 places. Every loss—every one of those 3,000 places—increased pressure on a beleaguered NHS. As the noble Lord, Lord Filkin, pointed out, those are the same facts that, this week, led the chief executive of Care England, Martin Green—a man who I know does not overstate his case—to advise care providers to start thinking clearly about how they manage their exit from publicly funded services. Already, three of the largest providers have signalled their intention to exit publicly funded home care. Meanwhile, in the last week, I have met local authority chief executives who are looking seriously at whether they need to re-enter the provider market to protect places.

This is, by any means, a serious situation, but is there a way out of it? Last year, I sat on the King’s Fund commission—which has been referred to by several other noble Lords—looking at the future of health and social care. We concluded that the current arrangements were no longer fit for purpose and that there needed to be a single budget for health and social care, with a single commissioner. After all, as the Chancellor said in his Statement in the last couple of weeks, the NHS cannot function effectively without good social care. They are interdependent. We also recommended a commitment to spend 11% to 12% of GDP on health and social care by 2025 and suggested what we felt were very practical ways for how this could be resourced, not least by rebalancing resources between the poorer and better-off pensioners. Again, others have referred to this but we felt clearly that there needed to be further investment in the social care sector. I, too, might ask: what has happened to the Dilnot money?

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Last month, we revisited our recommendations a year later and reluctantly concluded that things had got worse, not better, and that there was still no coherent strategy to address the problem—not least, the need to stabilise the care support sector. Since we published that follow-up, it is true that the Government have responded by allowing local authorities to levy a precept of 2% to fund social care but, as many others have said, that is nothing like the sum needed to make good recent losses. The poorer authorities with the greatest need will of course not benefit most from that proposal. Again, the need for a convincing, comprehensive strategy is even more urgent.

I said that I would not overstate the case, and I will not. I will merely read the concluding paragraph of the King’s Fund commission’s most recent report. If we take no action, the future looks like this:

“More people in need receiving no support at all. Fewer people receiving publicly funded social care. Care home providers closing in the face of rising demand … companies that provide care in people’s own homes leaving the publicly funded market. Individuals and families who are unlucky enough to need high levels of care continuing to face enormous, and uncapped, bills. Staff shortages leading to a rise in abuse and neglect as good people”—

and they are good people, who are no longer able—

“to deliver good care. And further pressure applied to the NHS that in turn is likely to lead to declining standards of patient care”.

That, surely, is a future that none of us would wish for, but it is a future that is upon us.

5.07 pm

Baroness Dean of Thornton-le-Fylde (Lab): My Lords, I, too, thank my noble friend Lady Wheeler for introducing this debate which, before I make my contribution, gives me the opportunity to rectify an unintended oversight on my part. In the debate earlier today on legal aid, I omitted to declare an interest as an independent member of the business oversight board of the Law Society. I would like to correct that omission now, with my full apologies to the House.

I would also like to declare for this debate that, as in the register, I am the president of the Abbeyfield charity for the provision of residential housing for elder members of the community, founded 60 years ago next year by a young man who came out of the Guards after the Second World War and felt that he wanted to put something back in. He identified that loneliness was a problem we were going to have because of the loss of our young people in the Second World War, so we started what has become a unique charity. We have 8,000 residents in 500 homes, and 4,000 volunteers. Our residents live as a family, independently within our homes, but come together twice a day for their meals. This model is unique.

This debate is about quality and viability. I would like to spend a few moments talking about quality because, as the right reverend Prelate the Bishop of Bristol said, this is really about people. I sometimes imagine what it must be like to work in a care home when we see all the bad stuff in the press, and how stigmatised they feel. Yet day by day, an overwhelming majority are trying to do a decent job working with

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older people. But the hidden message in the stuff we get in the press is that these are pretty depressing places.

I certainly agree with my noble friend Lord Lipsey, as I often do, about the image of residential homes too often being the wrong image. When I go into Abbeyfield homes I come out almost walking on air, because the joy in those places, and the way people feel they are living what is the end of their lives, is down to the quality of care they are receiving. It is not surprising that we have the most centenarian people of any housing or care setting. I sign letters of congratulation every month, and so far the oldest person is 110. So quality is important to the lives of these people, and being in the community is essential. We have something called Coping at Christmas, when any older person can come and have Christmas lunch and stay overnight—it is all free. It is about working in the community and it is about people.

Because it is about people, Abbeyfield decided in April last year to pay the living wage. We now have 15% less staff sickness absence and 15% less staff turnover than the average in the care sector. It is not surprising, but it shows the positive effects this can have. Of course, it is expensive and as far as we are concerned the whole sector needs to look at new models, and we need Government support to do that. The financial crisis in the sector—and it is a crisis—is overshadowing everything else good that is going on. We cannot allow that to happen.

We are building five new special dementia homes, which are leading the way. Given the financial crisis, do we go ahead and do that? We do not have any public funding—we are doing it out of our own funds. I am sure we will go ahead, but it raises questions and, as we have heard, there is less provision than there was. We have a scheme called specialist supported housing whereby retired elderly people who do not necessarily have to be in nursing care can be given specialist support, yet it does not qualify for supported housing grant. Why? It is because it is not regarded as a priority. Will the Minister consider supporting more of that? It is cheaper for government but we are not too bothered about that; more importantly, it is cheaper for us and better for our residents. It ensures that they live longer, fuller lives.

For his 95th birthday, we arranged a parachute jump for one of our residents. I could give many such examples. It is important that we do not lose sight of the fact that there is joy in the later years, and it is our responsibility to make sure that people enjoy those years.

The second element of this debate is viability. We need a development programme that addresses the issues that are challenging society, such as demographics, living longer and more people requiring such support. That means looking at different models, not just the standard model we have had so far. The Dilnot report showed the way.

We are often told in debates in this House that we have to agree to a particular policy because it was in the manifesto. Yet this was a central manifesto promise and the Government went back on it within months of being elected. That is unacceptable, and the Minister

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needs to answer this point. What happened to the £6 billion that was put on one side to fund this? What is it being spent on? Why cannot it be made available, even if the whole of the Dilnot cap is not to be applied?

This is an important debate that we will continue to have because the issues will not go away. They are not party political issues but issues about our community and the way we treat our older people when they retire. I hope the Minister can answer some of the questions put to him today.

5.15 pm

Lord Sutherland of Houndwood (CB): My Lords, I, too, thank the noble Baroness, Lady Wheeler, for giving us the opportunity to debate these issues, but I have to add the word “again”. My noble friend Lady Pitkeathley smiles at that. She coined a lovely expression in a previous debate; she referred to “the usual suspects” turning up. They are mostly here again; one is even on the Woolsack. The usual suspects are turning up and we have some new friends who will join the band. That is a good joke, but the disgrace is that we have to keep doing it. We have been doing it for more than a decade, often on the same critical issues. I pay tribute to my noble friend Lady Pitkeathley’s analysis of the need for the integration of health and social care services. This is the nub of providing good care. It will not deal with all the financial problems, but I will come back to that in a moment. Here we are again, and I will return to this point.

I should declare an interest as president of Scottish Care, which is the care home owners’ association. I have had briefs from Care England and Four Seasons Health Care. The most chilling part of the brief from Care England has already been mentioned. The chief executive is advising his members to consider the possibility of getting out of public sector provision. That is the size of the problem, and it is frightening.

A year or two back, Southern Cross Healthcare turned up its toes and gave up. The rescue that was mounted by the community of care home owners and groups of care homes was magnificent and meant that many of the clients of Southern Cross Healthcare did not have the great worry and concerns that otherwise they would have had about where they would be the next week and the week after. It was done by the community of care home providers, yet I doubt we could do it today. My first question to the Government is, do they have an analysis of the risks of that happening, of the risk of financial fall-out in the sector for reasons already given and of the risk if people are effectively on the street? I have seen at close quarters one care home close because of a fire. It was horrendous. It was 60 beds having to be vacated virtually overnight, but the troops rallied round. However, the question is, could we do it again?

In the few minutes I have left, I want to focus on viability. There are at least two key factors for viability, in addition to the funding issue that keeps recurring. The viability factors I want to point to are a high percentage of bed occupation and how much is paid for those beds. Unless there is, first, continually a high percentage and, secondly, confidence that the contacts currently being entered into with local authority

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commissioners will continue in future you cannot borrow money—it is difficult anyway—and you cannot get investors to put money into the system, so there needs to be both those things as well as adequate funding.

Why are these two factors so important? There is a shortage of cash in the public sector and therefore commissioning from local authorities is falling away. The criteria are tighter, and we have to live with that, apparently. There is also a malfunction in the conjunction between social care and healthcare, as my noble friend Lady Pitkeathley pointed out. We have talked about this for 20 years. In my 15 years in this House, this has kept coming up and yet it has not been solved. Oh, there are steps being taken. We will hear about these, doubtless. But it is not being dealt with adequately.

Let me give one or two facts and figures. We all know about what is referred to as bed blocking. That is at the extreme end of the malfunction, but of course there are many people—again referred to in the debate earlier—who are in hospitals and hospital beds, who neither want to be nor need to be. As for the figures, we have had 20,000 mentioned, 30,000 mentioned; these are the real numbers. This is not good enough. Put alongside that the fact that the 10 largest care home providers in Britain have 10,000 empty beds of high quality and providing nursing care. Those two numbers suggest something, do they not? We have to deal with the problems.

Add to that the further point that a delayed transfer—a bed blocking—will fill a bed that is costing between £1,750 a week up to £2,500 or £3,000 a week, while you can get good care home provision with nursing care provided for between £800 and £1,000 a week. That is half the price. Just put all these numbers together. I am not doubting the capacity of the Minister and his colleagues to count. Indeed the Chancellor of the Exchequer deals a pretty good hand of numbers himself; he could do well in Las Vegas. But actually putting these numbers together suggests obvious ways to go. Why are we not doing that? That will not solve the whole problem but it will begin to deal with the need to provide an adequate quality of care: how people want it, where they want it and how they need it.


Baroness Walmsley (LD): My Lords, I, too, thank the noble Baroness, Lady Wheeler, for allowing us to have this very long-awaited debate. There is so much to say about this issue that one hardly knows where to start. So many excellent points have been made in this debate. I think we all agree with the right reverend Prelate the Bishop of Bristol that this is about people. We must always bear that in mind.

The main point I want to make is that failure adequately to fund social care does not just impact on those people whose needs are currently not being met at all or only partly so, and their families, important though that is. This failure affects all of us now and in future. Although we will not all need social care in future, we all at some time will need the services of the NHS. The failure to deal adequately with social care is already impinging on the sustainability of the NHS and will continue to do so to an even greater extent in

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future unless something is done. The Government must not plan on a budget surplus by 2020 if it is at the expense of vulnerable old people in the short and long term, and the viability of our precious NHS which serves us all. It is simply not right and not logical. If they fail on social care, they cannot claim that the NHS is safe in their hands.