Baroness Pitkeathley interview

Torrin Wilkins: Hello, and welcome to the Centre Think Tank interview series, in conversation. My name is Torrin Wilkins, the Director of Centre Think Tank. Today, we will be discussing social care, the staffing crisis in the sector, unpaid carers, and the challenges facing the system, including our ageing population.

With me today to explore these issues further, I am delighted to be joined by Baroness Pitkeathley. Baroness Pitkeathley has a wide range of experience, including serving as a member of the House of Lords and as a Deputy Speaker.

She has seen firsthand the issues that we will be speaking about today as co-chair of the Carers All-Party Parliamentary Group and former CEO of Carers UK. So thank you so much for being with me today, Baroness Pitkeathley.

Baroness Pitkeathley: You are very welcome.

Torrin Wilkins: For my first question, the government has recently announced a new commission into adult social care, which will be led by Baroness Casey. This is by no means the first review like this. Is the new review necessary, or do we need large-scale action now to fix the social care system?

Baroness Pitkeathley: I think the answer to both of those is yes, we do need large-scale action now, but this is a start. I have the greatest admiration for Baroness Casey, who has a terrific track record of delivery. You are right in saying this is by no means the first time we have been around this track.

I remember when I was a member of the Lords during the Labour government of 1997, and a Royal Commission was set up and made a lot of recommendations then. It has been a long time coming, but I welcome Baroness Casey’s appointment, and I will do everything I can, as many other people will, to help her with her review.

Torrin Wilkins: In terms of the actual social care system and the fixes needed, what do you think the review could shed further light on, given that we have had so many reviews in the past?

Baroness Pitkeathley: We do have to go back to 1948 because when the NHS was set up, then, social care was not seen to be an issue.  The simple fact was that, at that time, men lived to an average age of around 66, just one year after retirement. Women lived to about 67 and a half or 68. Now look at the age at which people die, which is a wonderful achievement, with at least 20 more years of life on average.

It has brought the care needs of such people into much sharper focus. So it was not seen as an issue, but what people always forget is that social care, such as it was in 1948, has always been means-tested. It has never been free at the point of use, as the health service has. For the simple reason, it did not seem as though it was necessary.

Now, of course, it is necessary. It comes as a terrific shock to people to discover that when they are older, their elderly mother or father goes into a care home, they have to do a financial assessment, and they have to pay for it unless they have very, very little capital.

So it has been something that successive governments have ducked because it is a very major issue that requires a great deal of money, which in these difficult times we do not have.

Torrin Wilkins: One of the proposed solutions is to create a free at the point of use system similar to the NHS as it exists today. Is that feasible? Is it affordable? Would it solve the problems that we are having? Or is it a deeper, deeper issue than that?

Baroness Pitkeathley: I think it is a deeper issue than that.  I am all in favour of the National Care Service, but I think the very best that we can expect is to have some assessment at the point where you need care. The fact is, what we have got to do as a society, as a nation, is prepare ourselves for our own care needs in later life and for the care needs of our parents or indeed adults with disabilities and care needs.

We have avoided it as a society, and nobody wants to think about it. Nobody wants to plan for it, but we do have to plan for it. If anything constructive comes out of the review of social care, I think it will be an honest conversation. We are trying to have cross-party conversations now, which is very welcome.

We have to have an honest conversation about what your care needs are going to be, how they are going to be met, and what contribution you are going to make to them. Because to fund it out of general taxation at current levels is going to be impossible. I do not know if you have had any experience with what care in a residential or nursing home costs, but depending on where you live, it can be £4,000 a week.  People plan for their health needs, do they not? They do think ahead about what they might need. They even sometimes think about moving house to live in a more accessible place. We have to do much more of that.

By doing this, we might find that we might have more success ensuring that our care needs are better supported through the insurance sector, which has never stepped up to the plate on this. There has never really been a product that people were willing to buy to ensure themselves against their care needs because everybody hopes it is not going to happen to them. 

It is one in four, or maybe even one in five, people who incur such huge care costs. For most people, it is not such a vast sum at all, and so if we were to share the risk, like we do in health, some people cost the health service a great deal of money, others pass quietly away and hardly have used anything, and as a nation, we share the risk. That is what we have to learn to do with social care.

Torrin Wilkins: In terms of an insurance system, it is a really interesting idea, similar to what they use in Germany in some respects. Do you think there is a way to go about setting something like that up, given that the industry has not yet stepped up to the plate?

Baroness Pitkeathley: It would have to be some nationally set-up system. Maybe that is one of the recommendations that will come out of the social care review, who knows?

Whatever it is, it is going to require individuals to spend more money. I am a great believer in a hypothecated tax. I would put a penny on the income tax for everybody, and that would solve the problem. However, HM Treasury does not like hypothecated taxes, but people pay national insurance. When people retire, they do not pay national insurance, although many of them still do part-time work. That is another potential area we could look at to help fund this. 

Torrin Wilkins: One of the big debates that we often have is around social care, which sometimes focuses too much on care homes and social care at home. Critically, we overlook unpaid carers, the majority of whom rely on the £82 a week Carer’s Allowance. Should that be increased, and is there anything else that we can do to better support them?

Baroness Pitkeathley: You will never find me ignoring unpaid carers, and that is my main focus. They save the nation £192 billion every year, equivalent to the cost of running another National Health Service (NHS). They do that willingly and with love, but sometimes at great personal cost to themselves. Such as financially, because many people give up a paid job to become a carer, only to receive £82 a week, which is the lowest of all benefits.

It is not only financial costs they incur, but caring can be extremely stressful. It can be stressful to your relationships and your health, both physical and mental. Most carers who are caring for long periods and many hours a week report that their own physical and mental health suffers greatly. We need to be doing as much as we can for carers. 

Now I have been campaigning on this for 40 years, and we have made quite a lot of progress. If I tell you that 40 years ago, when I started in the caring business, the word carer was not in the Oxford English Dictionary, as it did not exist.

There is still a lot to do. Of course, carers have a better voice now, thanks to Carers UK and to the pieces of legislation that we have managed to get on the statute book for carers. Yet every carer I meet says, “Why did I not know? Why did nobody tell me? Why did the General Practitioner not refer me?” to places where I could get some help? It is the very best investment that we could make in social care because they are the cheapest and most effective form of care. So it makes very sound economic and moral sense to support those carers.

Torrin Wilkins: So you spoke a bit about the economic impact. Why do you think that has not made a greater impact on politicians? There is such an economic impact of people caring for their relatives, and as you say, saving the system such a vast amount of money.

Baroness Pitkeathley: Carers do not go on strike, do they? They do not even ever threaten to withdraw their labour.  I have noticed that when Members of Parliament themselves come across this, I have to say it would usually be their wife rather than the Member of Parliament who finds herself in a caring situation. They suddenly realise how inadequate the system is, and that is when they start to speak up for carers.

Caring takes place in a relationship. If you were not in a relationship with that person, you would never become their carer. That makes it quite different from the paid carers who come in to help you in that situation. The nature of that relationship is what activates the caring, and that relationship shapes how the caring is going to work.

Sometimes that works very well, but if the mother with whom you have always had a difficult relationship suddenly becomes frail and needs your help, that does not make it all sweetness and light. You do it anyway because you have a strong sense of obligation and duty.

I get very cross when I hear politicians say, as some of them still do, Oh, the trouble with our society is that families do not care anymore. Not from where I sit, families are still caring as much as they ever did, and even more now, because the system is letting them down.

Torrin Wilkins: On another issue, the care system itself does have a shortage of staff, and there are massive challenges with recruiting additional staff on top of that to fill the current shortages. How do we make caring more attractive, and what can be done more generally to tackle that staffing issue?

Baroness Pitkeathley: Yes, I am bound to say Brexit did not help because so many of our paid carers did come from Europe. Additionally, further restrictions on people coming and bringing their families have not helped either.

There are a huge number of vacancies in the care system. However, you can earn more money stacking shelves in Sainsbury’s than working in the care system, which often does not even pay you for your travel time between care appointments. So why would you do it?

 I have seen it work tremendously well, and I had a 104-year-old aunt who died just last week. We kept her at home all that time through the system of paying carers who came in to help her, and every one of them knew what she needed. They were sensitive and were wonderful, but why would you do it when the pay is so poor, and you have no chance of promotion, and you have no chance of career progression? 

Now, that is what we have got to do. We have to make it a much more attractive career. We have got to pay it better, but we have also got to recognise the skills that people have and give them an opportunity for promotion. Such as allowing them to move from being an unpaid carer to being a paid carer, to take training as a healthcare assistant, and to move to nursing. I have seen that happen all the time in the care system, but sometimes you have to fight the system rather than it facilitating you. I do believe that the government has that in mind and is very committed to improving the conditions of those care workers.

Torrin Wilkins: For my final question, I want to think a bit about the future of the care system in the context of an ageing population. What do you think the future of the care system will look like if we continue down the path we are on? What can we learn from other countries that deal with these challenges differently?

Baroness Pitkeathley: I think the care system is staggering on the edge of breakdown at the moment, and we do have to do something radical.

We have to fund it better and plan it better.  When I say we have to plan it better, I mean everybody. It is not just something you can offload to the government, either local or national. Of course, we have not mentioned the voluntary sector, which makes huge contributions in this area. All of those contributors need a lot more support and a lot more planning.

The best thing that we can do for the social care system is, as a nation, and as individuals, to think about what our own care needs are and start to plan for them and talk about them in our families.

It is a difficult thing to say, I know. I am old myself, and it is difficult for my kids to say to me, “Now then, Mother, what are we going to do with you when you cannot go into the House of Lords any longer?” Those are the conversations that do have to be had. I think if the attention around Baroness Casey’s review only does one thing, that is the most important thing it can do. Talk about it and plan for it.

Torrin Wilkins: Are there any other examples of other countries that might be useful to follow? I know we spoke a little bit about Germany before and their system.

Baroness Pitkeathley: Yes, there is Germany, there are Scandinavian problems. All of them are struggling, and developed nations are struggling with ageing populations and fewer people to pay the bills. What you cannot do is have a Scandinavian system, which has always been very good, on an American set of taxes, as you have to pay more for it in some way or another. 

Torrin Wilkins: Thank you so much for joining me today and discussing all these issues. I think it is a very good place to leave it, as you have to pay for it somewhere. So thank you so much for joining me today.

Baroness Pitkeathley: You are very welcome. Thank you.

Note: This interview has been edited for grammar, clarity, and flow. The original recording is the final and definitive version.