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Alex Cunningham (Stockton North) (Lab)
I look forward to serving under your chairmanship, Mr Brady. I am pleased that we have the opportunity to debate this important subject, which is being discussed more widely around the country by families and individuals who fear for their future.
The Government will try to boast that they are providing extra cash for social care, but that is not how people out there see things. “Hardest hit”—that is how the thousands of disabled people who marched in the streets outside this place last week described themselves. One woman from Billingham in my constituency, who has been blind since the age of 18, was among those who made the long trek to Westminster, and she told me about her anxieties and the effect that the cuts will have on her life. She and the other demonstrators had every right to be angry; they will be the hardest hit by the Government’s proposed cuts to disability benefits and the hardest hit by the swingeing cuts to council services that began this year, with more to come over the next three years. That means four years of anxiety and dread for families and individuals whose way of life depends on services with an uncertain future.
Last year, adult social care services helped 1.7 million adults to do things that most of us take for granted. Those 1.7 million adults remember the Chancellor speaking of his £6 billion cuts to local government grants and saying:
“Not a single penny will come from the frontline services that people depend on.”
How hollow those words ring today. I am sure the Minister intends to refer to the £1 billion that the Government are giving councils over four years to spend on social care services and to the £1 billion that doomed primary care trusts are supposed to spend on them over the same period—cash they are expected to take directly from the health budget, which the Prime Minister claims to be so protective of.
The trouble is that even the Conservative-led Local Government Association calculates that £4.6 billion is needed just to stand still and to maintain services as they are today. The reality is that the £530 million of additional funding that the Government have provided for social care in their first year is dwarfed by the £3 billion that councils have had to cut. According to the Financial Times and the Association of Directors of Adult Social Services, £1 billion of that has been cut from adult social care.
Lilian Greenwood (Nottingham South) (Lab)
Adult social care accounts for £1 in every £4 that my local authority in Nottingham city spends. Does my hon. Friend agree that it is inevitable that social care services will be affected when a local authority’s budget is cut by more than 16% in just one year, as Nottingham’s has been?
Alex Cunningham
It most certainly is. My hon. Friend says that social care accounts for £1 in every £4, and a 16% cut represents a considerable reduction in the amount available to spend on social care.
ADASS also concludes:
“savings on this scale simply cannot be achieved through doing the same things more efficiently or by trimming management costs”.
As for the money that has gone to PCTs, can the Minister tell us, hand on heart, that he has any idea how much of it will be spent on social care this year? Given the revolution unleashed by the Health and Social Care Bill, PCTs have had other issues on their mind as they have sought to protect services during a transition period that will see them abolished. More importantly, this transition period threatens to reverse the progress made on health and social care over the past few decades. I just wonder what guarantees there can be that we will have properly commissioned and funded care once PCTs have gone and have been replaced by consortia that do not have the expertise and understanding of our community’s wider health and social care needs.
Media reports just this weekend outlined the profits that some think can be made from the health and social care system, effectively taking hard cash from the front line. The Prime Minister’s senior adviser, Mark Britnell, told a New York conference attended by the giant private health care providers that dominate in north America that the changes over the next two years will provide a “big opportunity” for the profit-making sector. As I am sure hon. Members will know, no one can make profits without taking cash out of the system. I look forward to hearing what reassurance the Minister can give those who will be hardest hit. What is his guarantee that profiteers will not have their way with the NHS and related social care services?
I know that Ministers get fed up with MPs from the north highlighting the divisions in our country, but the BBC is highlighting them now. In a survey released last week, it identified a new north-south divide, with social care spending this year falling in the north while actually rising in the south, although I will question the value of that so-called rise later. The BBC’s findings reflect the differential impact of the cuts, with councils in the midlands and the north more reliant on central grants and thus hardest hit. The findings may also reflect demographic differences and the effect of falling property values on people’s ability to self-fund.
In the north, spending will fall by 4.7% in the current financial year alone. Then there are deprivation factors to be taken into consideration. Local authorities in the most deprived areas—many are in the north, but they are elsewhere as well—have the worst mortality figures and the highest incidence of long-term ill health, but they are suffering the deepest cuts in spending power. Front-loading the cuts means that huge changes must be brought in quickly, giving little time for consultation with staff and service users over the best way to minimise the impact on front-line services. That said, I would not like anyone to get the impression that things are rosy in the south. The 2.7% increase in spending in the south is about half the rate of inflation and does not keep pace with need. Nor will it be enough to prevent real people from losing real support—support that, in the Chancellor’s words, they depend on.
My main purpose in securing the debate, however, is to consider the human impact of social care cuts, not just to debate dry spending figures.
Anne Marie Morris (Newton Abbot) (Con)
I note what the hon. Gentleman says about funding. He briefly mentioned the issue of commissioners and quality, which is clearly as important as funding. Does he share my concern that the changing role of the Care Quality Commission, which will now monitor providers rather than commissioners, will mean that there is a gap and therefore a risk that commissioners will not be held to account and provide good-quality care?
Alex Cunningham
Yes, I agree that there is a considerable risk. I should say that I have been much impressed by the role played by local authorities in health scrutiny. I hope that the Minister will answer the hon. Lady’s question directly later.
The successful judicial review against Birmingham city council’s adult social care cuts looks set to be hugely significant. The Minister might be tempted to hide behind a carefully drawn veil of localism, but does he really consider it acceptable that Birmingham should seek to withdraw support from 5,000 people? Many of those people could be in a situation where abuse or neglect have occurred, or will occur, or they could be unable to carry out the majority of their personal care or domestic routines. They will be the real losers in all this.
Does the Minister consider it acceptable that 2,145 elderly and vulnerable people in Lancashire will have all care and support removed, as part of cuts that are the subject of another judicial review? Does he consider it acceptable that desperate families are being forced to go to the High Court to try to prevent devastating damage to their quality of life or that of family members?
In West Sussex, the “Don’t Cut Us Out” campaign has brought people together to campaign against eligibility cuts. If Members visit its website, they can read testimony from Tony, who has limited mobility. He must carry an oxygen cylinder wherever he goes and he is susceptible to blackouts and periods of deep depression. He will lose all the benefits and support currently provided by West Sussex county council. He says:
“My current care package...provides for 13 hours of care support each week and has kept me out of hospital for much of the last two years, saving the Country hundreds of thousands of pounds. Before, I was in hospital for six months at a time, and once discharged was being re-admitted every two weeks or so. I can’t imagine what my life will be like without this support.”
Back in the north, local people, service users and staff have been campaigning to halt the closure of Leeds crisis centre and the threat to mental health day services in Armley and Hunslet. At a packed campaign meeting organised by Unison, a campaigning trade union of which I am proud to be a member, a service user said, “I am saving the council money by using these services; when living in London, where there weren’t these services, I had many hospital admissions; I have had none since living in Leeds.”
Mencap provided me with a graphic example of what the cuts mean for George and his daughter, who are from Rotherham. George’s daughter has profound and multiple learning disabilities. Due to her disability, she is doubly incontinent and requires the use of many disposable items of medical equipment. She lives with her dad, and as part of her care package, the council picks up all body and medical waste from the household. The waste includes faeces, urine, blood and vomit. Mencap says that Rotherham council has gone from collecting the hazardous waste once a week to once every 14 days and has reduced the amount that it picks up by 50%. The council has also stopped providing specialist waste bags for the disposal of the waste, leaving the family to cover the additional cost themselves. That bodily waste now goes into black bin bags mixed with household waste, which are sent to landfill. These stories illustrate the fundamental truth: these cuts are a false economy with devastating human, social and economic costs.
In a recent national survey by a group of charities, including Carers UK and the Alzheimer’s Society, half the respondents said that increased charges for care meant that they could no longer afford essentials such as food and heating, and more than half said that their health had suffered as a result. We must consider the services run by voluntary organisations—dare I say it?, the big society—that offer early help for people who do not necessarily qualify for assessed council support. Day care centres, meals on wheels, support groups and drop-in centres are being cut because they are losing grant funding.
Jackie Dray used to run four support groups called “Elders with Attitude”—I love that name—in Birmingham, but she was told in March that her £30,000 council grant was to be cut altogether. She now runs only one group and is desperately looking for alternative funding. She said:
“They are cutting luncheon clubs or groups like mine that could make a difference between somebody remaining in the community or sinking into clinical depression and residential care. For a small amount of money, you could delay the point at which people have to go into hospital. I see a lot of clinical depression in carers and cared-for alike. People are teetering on the brink. There’s a lot of frustration, worry, lack of sleep.”
Before we can consider the future of social care services, we have to consider the consequences fully.
While we await the Dilnot commission report on long-term funding and the Government’s response to the Law Commission review, the Government are, in effect, already re-engineering the infrastructure of care and support. As services are razed, my fear is that capacity is being lost, services are being withdrawn and staff are being lost—capacity and skills that cannot easily be recreated. The Government are seeking to soften people up and lower their expectations, to get them to accept a return to reliance on family and buying from the open market with their own funds, or a patchwork of precarious charitable provision from a third sector suffering its own cuts and challenges.
I want to turn to the ideal, which I thought all the parties shared, of personalisation in adult social care. I fear that that ideal is being lost. The cuts mean that the policy, which promised much, is fatally undermined. Social workers and care managers tell their union that they are being expected to reassess personal budgets with a view to cutting them. I know that they need to consider value for money for all care packages, but they believe that they are expected to make cuts to get the budgets down.
A forthcoming report on a survey that Unison conducted with Community Care will highlight the fact that the paperwork and bureaucracy associated with personal budgets is excessive and inaccessible for service users. I question the Minister’s decision to prescribe from Whitehall that personal budgets be provided in the form of direct payments. That appears to be at odds with his claim to be a champion of local determination and removes choice from people who wish to have a managed budget. It appears to be linked to the aim of completely withdrawing state provision. Individuals will be expected to navigate the market or take on what many will see as the onerous and stressful responsibility of becoming an employer. I urge him to reconsider the prescription of direct payments, as there is evidence that it will restrict choice, but more importantly, distress some of our most vulnerable people, who already have enough challenges in life.
As we contemplate the future of adult social care services, there can be no under-estimating the scale of the challenges that we face as a society: by 2041, the number of adults with learning disabilities, we are told, will have risen by 21%; the numbers of young people with physical or sensory impairments by 17%; and disabled older people by a massive 108%. We all know that the number of dependent older people is set to increase hugely. The Association of British Insurers says that currently 20% of men and 30% of women will require long-term care at some point. If we add to that the challenges of the increasing number of young adults with complex needs who will need very expensive care packages for decades; the 170,000 people with a learning disability who Mencap tell us live with parents and carers who are already over 70 years old; the growth in the number of people with dementia, which the Alzheimer’s Society says is set to soar by a third to 1 million people by 2025; the costs facing authorities due to alcohol misuse; and the number of people with obesity-related problems, then we can see that the Government’s proposals are destined to fall well short of what is needed.
The director of children, education and social care for Stockton-on-Tees borough council, which serves people in my constituency, says that we have to be mindful of the knock-on effect of the reduction in other funding streams that impact on adults—the independent living fund, the Supporting People programme and affordable housing funding. She tells me that some of the funding streams that have historically been linked with it are being reduced or ceasing, while her department works to maximise people’s independence.
Lilian Greenwood
Does my hon. Friend share my concern that these cuts come alongside the cuts to disability benefits outlined in the Welfare Reform Bill, in which Ministers talk about targeting those in greatest need? Is not there a danger that disabled people with moderate needs could lose all support and face isolation and a loss of independence?
Alex Cunningham
That is very much the case. A stream of people have come to our surgeries or to see us in Parliament, and there seem to be so many attacks—left, right and centre—on some of the most vulnerable people in our society. As my hon. Friend says, something needs to be done if we are to arrest this situation.
The director of children, education and social care for Stockton-on-Tees borough council says that the result of the cuts, if we have limited extra care and supported living options, will be a further over-reliance on residential provision. An integrated health and social care facility and extra care scheme in Billingham in my constituency was an important part of my council’s strategy for supporting people, but the Government refused the private finance initiative credits to make it happen. Would the Minister prefer his granny, mother or other elderly relative to be forced into residential care when they could have been supported in their own home or an extra care facility and had the independence that I know most older people want?
Another area of concern is the shortfall in funding to support carers. Yes, I know that the Government allocated a welcome £400 million for carers’ breaks, but other funding managed by PCTs to support adults and their carers is not ring-fenced in any way, and although some flexibility is needed, carers, who are often seen as the poor relation, could end up all the poorer.
The sector skills body estimates that the social care work force needs to double by 2025, yet it is a sector characterised by labour shortages, low pay, poor prospects and a poor image. Some 60% of care workers hold no care qualifications, and only 20% have a national vocational qualification level 2; only 10 % have an NVQ level 3. Before anyone intervenes on that point, I should say that I believe that previous Governments, including our own Labour Government, could have done more to address that issue. However, it is not just Governments’ responsibility; other organisations, including service providers, should play their part in driving up qualification standards and meeting the costs.
Is the provision made by such organisations being properly managed or being left to the market? In Stockton, we have over-provision of residential care places, some of which are under financial pressure, including those owned by Southern Cross, which is seeking £100 million from investors to secure its future. Surely we need some kind of controlled management or strategic planning to get this right and ensure that standards are maintained.
We must look to the future of adult social care. We need immediate action to lay the groundwork for genuine reforms to flourish. The Chancellor said that his cuts would not touch front-line services; he should be prepared to say that he got it wrong. There is an urgent need for a new plan that looks again at the local government settlement and works with local authorities to ensure that front-line services are funded to meet need. Everybody agrees that we must do more to give early help because it prevents dependence and saves money on acute care, and yet those services are first in line for the chop. Will the Minister genuinely and strenuously consider the recommendation of a duty to provide early help for adult services such as that which Professor Munro made for children’s services?
The Minister must reconsider the equation of personalisation with the transaction of receiving direct payment. Personalisation is not about ticking boxes and having the right number of people receive direct payment. Trying to make it work in the context of the cuts requires him to spend time talking to practitioners and service users about what is happening on the ground and what they think the priorities should be. We need to get it right for individuals.
We need an improved and comprehensive work-force strategy covering training, development and qualification standards as a condition of provider registration and a commitment to working towards a living wage for all care workers. We must work with work-force representatives to boost the autonomy and confidence of practitioners. I am sure that the Minister will welcome, as work-force regulators have, Unison’s duty of care handbook for health and social care staff. The handbook aims to promote awareness among workers of their duty of care and other professional duties, and of how to raise concerns about poor practice.
Costs, too, need to be addressed urgently. The Association of British Insurers says that the average cost of care in residential homes in the UK is approaching £25,000 a year, with people in England spending an estimated £420 million a year on private home care. This question was not sensibly debated during the general election. We need cross-party co-operation to reach a long-term sustainable solution to the problem.
Anne Marie Morris
The hon. Gentleman raises a question about care homes and fees. Does he agree that one way to solve the problem would be to introduce a standard contract? At the moment, there are great differences in provision; there is no consistency in standards, which means that one person’s care can be very different from another’s.
Alex Cunningham
During my time I have visited many care homes, and I have seen many variations in quality and standards. I have seen some places where elderly people were highly motivated and excitedly engaged in activities and others where people were sitting in seats glued to the television—at least, I think that they were glued to the television; they certainly seemed to be in another world. I agree with the hon. Lady that we need a solution of exactly the sort that she outlines.
There is an overwhelming desire to end the postcode lottery for care. It is important that when people move around the country, they should receive the same standard of care without their cases being constantly reassessed. Recommendations made by the Law Commission for national eligibility criteria and carer assessments are a start in plotting a way forward. We must end the cost-shunting and turf wars between health and social care over continuing care assessment and funding. Do the Government still intend to allow the Law Commission to draft a Bill to simplify the legislation, and if not why not?
When Dilnot reports, we need to hear from Ministers a genuine commitment to cross-party engagement on long-term funding. The Minister must realise that a voluntary insurance market, like that described by the Prime Minister’s senior adviser this weekend, will not be acceptable to a public worried about the workings of the discredited financial services sector.
As well as a new funding system, we need to review the quality standards of service regulation, with greater emphasis being placed on the importance of providers having a stable, highly skilled and confident work force. The quality of care is all about the quality of relationships, but for as long as we have a 25% turnover of care staff we are letting down the hardest hit, who deserve much better.
The future of social care and its funding is not a matter only for this generation or this Government. We all have a responsibility. I hope that the Minister accepts that the Government should not go it alone, but should work with everyone involved to find the kind of long-term solution that will help to ease the anxieties of an increasing number of disabled and elderly people.
I end with a question for the Minister. If we are all in this together, why is it that adult social care is the hardest hit? Is it not the case that the most vulnerable are taking a disproportionate hit? I hope that the Minister will accept my points and other constructive points made during this debate, and that he will answer our specific questions. He should reflect on the unfairness of what is going on. He should realise that despite all the statements, funding is not meeting today’s needs and that current plans will not address the increased demands of the future. I hope that he will tell all those who receive adult social care services that he will make changes to current and future plans to ensure that the most vulnerable have a quality of life that most of us take for granted.
Catherine McKinnell (Newcastle upon Tyne North) (Lab)
It is a pleasure, Mr Brady, to serve under your chairmanship. I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing this morning’s debate, which concerns an incredibly challenging and complex matter.
I am concerned that few Government Members are here today, so I congratulate the hon. Member for Newton Abbot (Anne Marie Morris) on attending. That makes me think that we are not all in this together, and it seems that only Opposition Members wish to represent their constituents on this matter.
I wish to contribute to this debate specifically on the standard of care being provided to vulnerable elderly people. I recently participated in a series of hard-hitting reports by Tyne Tees Television’s “North East Tonight” programme. Tyne Tees’s findings on the standard of care provided in some care homes in the north-east were distressing and disturbing, and I am pleased to have the opportunity today—again, I thank my hon. Friend for securing the debate—to highlight some of those concerns and present them directly to the Minister.
I must point out that there are some fantastic care homes in the north-east and that they have some dedicated staff and carers. However, the “North East Tonight” reports were timely, being broadcast in the same week that a paper by Newcastle university’s institute for ageing and health predicted a care home crisis unless there is major investment in the care system to support the rapidly increasing number of elderly people.
In 2010, there were 2.6 million people aged over 80, but by 2030 that figure is expected almost to double to 4.8 million, with one in five needing regular care. The Newcastle university paper predicted that there will be an 82% increase in the number of care home places needed—that is 630,000 extra places between now and 2030 just to cope with the demands of an increasingly older population.
In its investigations, Tyne Tees uncovered reports of former care-home workers who were forced to leave their jobs. Those workers were given bad references, which make future employment in the sector difficult, because they had blown the whistle on the unacceptably poor standards of care. That included lifting the lid on cases of dangerously poor hygiene, of residents not being fed properly, of a lack of interaction between staff and residents and of a total lack of stimulus for the people living there. The investigation also uncovered cases of appalling neglect of vulnerable care-home residents—according to relatives, it was often because there were simply insufficient staff on duty to ensure that their loved ones’ needs could be properly taken care of.
Tyne Tees also reported that many relatives were afraid of reporting concerns about the quality of care being provided, because they thought that it might put their loved ones in greater danger. It is understandably difficult to complain about the poor standard of care being provided for a relative when, in the first instance, the complaint has to be made to the people who are providing it.
Tyne Tees invited me to view its findings. What immediately struck me, as a mother of young children, was the contrast between the standard of care provided to young children in child care settings and the standard of care provided to vulnerable elderly people in care homes. If Tyne Tees had uncovered similar cases of neglect and fear of whistleblowing in nurseries in the north-east, I am sure that there would have been a national outrage, and rightly so, yet the treatment of older people is too often shamefully brushed under the carpet.
The Tyne Tees series of reports received unprecedented feedback through e-mails and Facebook comments, and people wrote to Tyne Tees to back up its findings and report similar concerns. That shows the level of concern across the north-east—and, I am sure, across the country—about the situation.
I recently had to intervene in support of a family seeking help for Jessie Wiseman, an elderly constituent. She is 91 and blind, and she was found living in squalor after ambulance workers paid a routine visit to her property. Despite concerns having been raised by her GP and her son about Jessie’s deteriorating condition, social care workers failed or act and she rapidly declined. That is why I welcome the recommendations in the recently published Law Commission report to introduce a set of statutory principles, a statutory basis for adult safeguarding boards and a duty on councils to assess carers and investigate adult safeguarding cases.
Mr David Anderson (Blaydon) (Lab)
Is it not the case that the failings in adult care have gone on for a long time, because, unlike child care, it has never had a statutory basis? In arguing for such a basis to be put in place, we may find that the Government say that this is just more red tape and bureaucracy.
Catherine McKinnell
I agree that that is a great concern, which is why the Minister must take on board the deep concerns that are being expressed today. In any event, reforming the law will still not be enough.
I am pleased that, as a result of the Tyne Tees investigation, the Care Quality Commission has agreed to review its reports and to conduct unannounced assessments on the homes in question. However, I am concerned that it appears to have required a television programme to spur the Care Quality Commission into action. By placing their loved ones in residential care, people are putting huge amounts of trust in a service. They rightly expect that the Care Quality Commission is adequately monitoring, regulating and inspecting all care homes on a frequent basis.
Anne Marie Morris
The hon. Lady has made some extraordinarily good points, and the Care Quality Commission certainly needs more help to do an effective job. Now that we have an outcome-based set of performance criteria, homes need to be given guidance on how to comply with them. In my meetings with the Care Quality Commission, it says that it no longer gives advice, which means that it is an uphill battle for any home to ensure that it provides the quality of care that is needed and that it complies with the new criteria.
Catherine McKinnell
I agree that the Care Quality Commission should take a proactive approach to improving the quality of care in our adult services.
Another worrying statistic is that on-site inspections in care homes have fallen by 70% since the Care Quality Commission was introduced in October 2010. That must worry anyone who lives in a care home or who has a loved one in a care home.
Will the Minister consider the following issues because they are crucial to the future provision of social care services? What further steps can the Government take to ensure a much greater level of protection and safeguarding for vulnerable elderly people in residential care? What measures will he take to ensure that the culture of fear that was spoken about by people participating in the Tyne Tees reports is broken down, so that care workers, relatives and residents feel confident and safe in raising concerns about the standard of care? What steps is he taking to improve the status, pay and training of care home staff, who are doing an incredibly difficult and important job? How will he ensure that the swingeing cuts to local authority budgets over the coming years do not detrimentally impact further on the quality of social care being provided to elderly people, particularly at a time of ever-increasing demand?
Mr David Anderson (Blaydon) (Lab)
It is a pleasure to be serving under your chairmanship, Mr Brady. I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing this debate, which is timely not just because of the demonstrations that we saw outside this place last week, but because we are in the pause before the Health and Social Care Bill comes back to Parliament. This debate is also a matter of great personal passion. In 1989, thanks to the behaviour of a previous Tory Government, I lost my job in the coal industry and had to take up a job in care. Although I ended up in that sector almost by mistake, it was one of the best things that ever happened to me. I met some fantastic people who were dedicated to taking care of the frail and vulnerable people in the city that my hon. Friend represents. Sadly, in the early 1990s, a lot of that care, commitment and dedication was lost. A series of cuts from the national Government decimated the care services across the whole country, and we see the same happening today.
I hope that the Health and Social Care Bill will be withdrawn in its entirety. Despite what they say, it is clear that the Government are leading us to a privatised NHS. The experience of social care should show us what happens when we put services out to the private sector. We are told that the White Paper has been delayed. There may be some last-minute qualms from the Government about how far they can go against public and professional opinion. I am surprised that the pause has happened now, because public and professional opinion has always been against this Bill, even when it was first announced. Perhaps that opinion took a while to sink into the minds of the Government; it certainly did not immediately sink into the minds of the Liberal Democrat members. It clearly has now, and thank God for that. I hope that the Minister, along with his colleagues in his party, will work with other people across society to ensure that the Bill does not go any further and that we do not see the same damage to the health service that we have seen to the social care services.
Research carried out by Unison suggests that, if recent trends continue, the last council-run residential care homes will have closed in 15 years’ time and there will be no local authority-employed home care staff left by 2020. That is part and parcel of this Government’s drive not just to boost the private sector but to deconstruct public sector provision and give councils less and less responsibility. The anti-public sector phalanx in the Cabinet will, I am sure, be happy to see that happen and it will celebrate the disappearance of council-run services. It will argue that the private sector always performs better, despite the fact that that has not been shown to be the case.
Alex Cunningham
My hon. Friend is talking specifically about local authority provision of care homes. Is it not more important that we invest in extra care facilities and that we work with elderly people so that they can live in their own homes, because that is what the vast majority of them want to do?
Mr Anderson
I agree with my hon. Friend. My own personal experience was in a purpose-built site that did just that. We took in people for a week at a time for respite and we also provided day care, but the individuals all lived in their own homes. Although that was cost-intensive in labour terms, the quality of care was good. We took care of not just the individual but the needs of the family, and we built very close working relationships with them. If we want to have quality care in this country, we must bite the bullet and accept the fact that we have to pay for it. The previous Government accepted that if we wanted quality health care, we had to increase the public payment into it.
Catherine McKinnell
In my contribution, I highlighted the worrying case in my constituency of Jessie Wiseman whose care at home was contracted out to a private care provider. Some 15 visits took place over eight weeks before she was discovered in an appalling state. However, the local authority took no responsibility for it. This story feeds into the debate on the worrying trends that can take place when services of this nature are put out to the private sector.
Mr Anderson
The privatisation of home care services in this country has been a complete failure and a nightmare. I have represented home care workers for many years and have seen the service deteriorate. We had a dedicated work force who had a set list of clients whom they went to see day in, day out. They built a relationship with that person and their family. When those jobs were contracted out, it was said, “We will send worker A on this day and worker B on that day.” The home care worker lost that direct link with not just the family but the wider team within the authority. That team would work together and take a holistic view and work better for the person concerned. It is clear that services are being contracted out to save money. If we save money, services will not be as good.
It is clear that we will see problems being stored up if we lose public sector capacity in home care services. At the moment, some 31,000 residents are being taken care of by Southern Cross Healthcare. Their homes now hang in the balance as a result of reckless business practices and local commissioning, which has allowed the organisation to become so dominant in the market. Southern Cross and Four Seasons—the big two in residential care—have operated casino-style finances, and both are now teetering on the brink of collapse. A toxic cloud, formed by irresponsible borrowing, weakening demand, council cuts, the slump in care home property values and the collapse of favourable credit facilities, now hangs over the heads of frail elderly people and their families at a time of insecurity and when they need real security.
How has it come to this? How has RBS, a state-owned bank, become the biggest shareholder in Four Seasons in exchange for writing off debts of £300 million? Would taxpayers’ money not be better spent directly on care homes run by democratically accountable councils, rather than being tied up in byzantine financing arrangements?
Across the social care market, research by Community Care suggests that one in five providers expect to go out of business in the next financial year. The regulator describes the home care market as a cottage industry of small, often barely viable providers alongside a few giants such as Care UK, whose chairman kindly provided £21,000 to fund the personal office of the Secretary of State for Health—perhaps that is one reason Care UK is doing so well.
If Southern Cross, Four Seasons or indeed local providers collapse, how will local authorities find new homes for people when they no longer run them? When home care providers default, as they often have and might in future, how will local authorities fill the gap if they have scrapped their own home care teams, which is happening up and down the country?
What about the quality? Care Quality Commission data show that privately provided care services are less likely to be rated “good” or “excellent” and five times more likely to be rated “poor”. I know that the Government do not like targets or standards, but when their own commission is saying such things its message should be listened to. Private providers consistently score lower on a range of indicators of quality and safety. When we look at the employment practices of some providers, we cannot be surprised that home care workers do not stay in their job. They are not paid for their travel time between visits, and they have to provide their own mobile phones and pay for their uniforms. They suffer from underpayments; they often have zero-hour contracts; and they sometimes have to pay towards the cost of administering their own time sheets. No wonder people do not see it as a job for the future or a career that it is worth investing their time and talents in. We need real regulation of employers to stamp out employment practices that have impacted so badly on home care users and, through them, on staff.
Where are we today? We have a Government who want more from staff for less; who want more work by fewer staff, because they are making 500,000 public sector workers unemployed; who want more pension contributions from less pay and for poorer pension provision; and who want people to spend more time at work by making, in particular, women work until they are 66 years old, with less time at home and in retirement.
What did we get last week? The Chancellor has a new red tape initiative. What is he going to do when people are losing their jobs? If there is a chance of redundancies being managed sensibly, what does he talk about? He wants more chances of people being sacked, with less chance of real support by limiting the time to consult. People will have more chance of being made redundant and less legal support to challenge decisions taken by their employer.
The CQC sees a vacuum in regulation and in the checking of safety and quality of care. The CQC’s risk-based approach is resulting in a dramatic drop in inspections. A freedom of information request by Community Care found a 70% drop in CQC site inspections in the past year alone, at a time when more people are in need of care.
Anne Marie Morris
I thank the hon. Gentleman for being so generous in giving way. The statistics are interesting, but care homes in my constituency of Newton Abbot complain that more visits are being made. I spoke to the CQC just this week and it said that it was making on-site visits to every home within its purview in the south-west. There might be a regional difference, but in the south-west, where there are a huge number of elderly people, the number of visits is going up, not down.
Mr Anderson
I thank the hon. Lady for that. More inspections are good: we want inspections that work; otherwise, we will get into the problems that my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) mentioned.
Staff and service users fear that there is an over-reliance on provider self-assessment and secondary sources rather than direct inspections. There are fewer indicators and data sources for adult social care providers than there are for NHS providers, yet the methodology is common. Alongside a “lighter touch” approach from the regulator, local authorities are cutting quality assurance departments, which, as Community Care showed, means fewer local checks on the quality and safety of care being provided.
Some of the changes that the unions and workers at the CQC would like to see, which I agree require serious and urgent consideration, include reinstating and strengthening the requirements on the types of incidents and issues that must be reported to the regulator. These should again include medication errors, significant injuries, accident and emergency admissions, safeguarding referrals, matters where staff are subject to disciplinary action or dismissal and unusually high staff turnover. Those are all indicators of things that might be going wrong, but they are not being recorded as they should be. A minimum frequency should be set for how often a service is visited.
I have no doubt that the hon. Member for Newton Abbot (Anne Marie Morris) is correct about the experience in the south-west, but it should be replicated across the country because it would give people greater confidence that things were being done properly. There should be a greater range of tools so that service users and employees can make their concerns known to people who can affect outcomes. We want to encourage people who want to blow the whistle where necessary, and give people whose relatives are in care confidence that, if they make a genuine complaint, the care will not be reduced.
I hope the Minister will look at my points, provide answers on the failures of private adult social care providers and say whether anything can be done to make the CQC more representative. For years, adult social services have been regarded as the Cinderella service, which is a disgrace. People are in care not because they want to be but because they have to be, so I hope we will work together to try to make adult social care something this country can be proud of.
Lilian Greenwood (Nottingham South) (Lab)
It is a pleasure to serve under your chairmanship, Mr Brady.
I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing this debate on an issue of huge importance to many of our constituents, who are among the most vulnerable in society, including older people, disabled people and carers—people for whom adult social care services are an essential source of support in their daily lives.
My hon. Friends have eloquently and passionately articulated the real and serious concerns about adult social care services, but I want to focus on the importance of the social work profession in building adult social care services fit for the future.
Labour Members are pleased that the Government have proceeded with the work that Labour started on reforming the social work profession, and I welcome the Government’s decision to continue to support the work of the Social Work Reform Board. As a consequence of cuts to budgets for adult social care services, it now feels as though the very future of social work with adults is under threat. Councils across the country are proposing deep cuts to the number of registered social workers they employ, to be replaced with a range of staff employed in roles such as care co-ordinators and support workers. I know that the staff are committed and caring, but, like my hon. Friends, my concern is that this restructuring is prompted not by seeking to improve the quality of care but by the need to reduce spending on salaries. Like my hon. Friends, I am fearful of the consequences of this loss of capacity. It represents a serious loss of skill and expertise in the work force, at a time when people’s physical, mental and emotional needs and family dynamics are becoming ever-more complex.
It is hard to escape the impression that social workers in adult services are, as my hon. Friend the Member for Blaydon (Mr Anderson) said, the Cinderella service—the poor relations. The media attention given to tragic deaths of children as a result of abuse has served to sharpen public focus on children’s social work, but the consequences of social workers in adult services being poorly managed, supported, valued, trained and developed are just as critical, as my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) pointed out. Excessive case loads, defective IT systems and too much paperwork are also facets of adult social workers’ daily lives, and they get in the way of those workers’ ability to practise effectively.
The Government have said that they have given the Children’s Workforce Development Council £79.9 million for social work initiatives in 2011 and 2012. There is work to develop an advanced professional status in children’s social work to enhance the development of those who want to progress in front-line practice rather than in management, and the Munro review of barriers to direct social work with children and families has come up with some excellent recommendations—all to be welcomed. Does the Minister understand, however, that the lack of similar investment and activity in adult social work is leaving practitioners feeling overlooked, and has knock-on consequences for morale and future recruitment and retention? What plans does he have to address those concerns?
My trade union, Unison, represents 40,000 social workers and has developed a 10-point plan for social work within adult services. I support its call for a “clear political commitment” through “policy and regulation channels”:
“to strengthen the role of social work in adult services”
covering the
“central importance of social work in care and support of adults, and…halting the development of ‘social work on the cheap’.”
Is the Minister willing to give such a commitment?
A survey last year of social workers in adult services found that two thirds of respondents felt that the time they had available to spend with each service user was not sufficient to meet their needs, and that nearly a quarter felt that the time available was very insufficient. An overwhelming 96% of respondents believed that too much of their time was spent on paperwork, and only a third believed that joint working with the NHS was effective in their area. They reported structural difficulties, such as remote management, the marginalisation of social work and the duplication of paperwork required because of incompatible IT systems. Although only 3.5% of social workers in England are directly employed by the NHS, many more are seconded to the service from councils, but the status, standing and representation of social work in the NHS is virtually invisible.
Social work plays a vital role in mental health services, addressing the social needs and safeguarding the rights of patients, and hospital social work is essential in enabling rehabilitation and preventing readmissions. A recent survey by Counsel and Care stated:
“Hospital social workers are being bypassed by health professionals, who in some cases are dealing directly with the family rather than using the social worker service to plan discharge...The hospital teams can sometimes function as ‘brokers’, trying to discharge older people in to care homes themselves without proper assessments being undertaken by social workers.”
Does the Minister agree that NHS trusts should ensure that social work is represented in their management and governance structures to prevent such practices? Health employers need to engage much more closely with the social work reform agenda, accepting responsibility for playing their part in its implementation.
Adult social care services are vital and will be increasingly needed in the future, as my hon. Friends have pointed out. Social work faces a number of serious and pressing issues, and I look forward to hearing how the Minister plans to address them.
Emma Reynolds (Wolverhampton North East) (Lab)
It is a pleasure to serve under your chairmanship, Mr Brady.
I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing this debate on an incredibly important issue. It is a great cause for celebration that people now live longer, but it brings new challenges. Our society—and our Government—should be judged on how we look after our most vulnerable people, and I want to focus my contribution on the care of the group of people who tend to be the most vulnerable: the elderly.
My hon. Friend said that there is a large, sustained increase in the percentage of people needing long-term care, and the projection is that the figure will continue to rise. As has been pointed out, the standards of care in care homes vary greatly, not only across the country but within regions and sometimes within cities—there is even variation across my constituency of Wolverhampton North East. My grandma is in a great care home in neighbouring Staffordshire, which provides wonderful care, and I want to pay tribute to the care workers there, and to those across the country in good care homes. We know, however, that that is more the exception than the rule.
I am very concerned about the drop in the number of inspections of care homes by the Care Quality Commission. I echo the questions asked by my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) about how the Government can guarantee that care home standards across the country are at least good—not poor—and how they can stop those who seem to want to make a quick buck out of the industry and ensure that care home staff are given basic protection rights and paid properly.
I want to turn to the pressing issue of the financing of care, which the previous Labour Government tried to deal with perhaps a little too late. Thousands of people across the country have to sell their homes to fund long-term care, and the cross-party talks regrettably broke down before the general election, with the Conservatives preferring to score political points and publish posters about a “death tax” rather than engage seriously with this most important issue. However, I congratulate the Liberal Democrats, in particular their then health spokesperson, the hon. Member for North Norfolk (Norman Lamb), who stayed in the talks and was willing to reach some kind of consensus.
I know that the Minister will not want to answer some of my questions because the Government are awaiting the outcome of the Dilnot commission, but I urge him to consider the shortcomings of a voluntary contribution model. Experts in the insurance industry have pointed out that people are unlikely to take out insurance 30 years before they might need the care, and international evidence suggests that such a system is unworkable. France has the largest voluntary insurance market for long-term care but there is only a 15% take-up, so if the Government go for that option, which was in the Conservative manifesto—I am waiting to see what the coalition will do—it is almost as good as doing nothing. If we introduced the model and people did not take up the care, we might as well have done nothing at all.
My hon. Friend the Member for Stockton North said in his closing remarks that this is a matter for generations to come, and it is most pressing that we have a system that enables the Government to provide care for the elderly in the years to come. I said at the start of my speech that this is a great cause for celebration, but it brings a new challenge, and I urge the Minister to consider the value of making this a cross-party issue and ensuring cross-party consensus on the financing of long-term care for the elderly.
Emily Thornberry (Islington South and Finsbury) (Lab)
I do not believe I have served under your chairmanship before, Mr Brady, and it is a pleasure to do so.
I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing the debate, and on his excellent contribution and the moving examples that he put before us. The truth is that not enough time is spent in the House on this fundamental issue, which is vitally important to many of our constituents; but we have had a very good debate today.
There seem to be two issues here: the structural problems and the cuts. My hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) touched on standards of care and on ensuring proper status for social care workers. My hon. Friend the Member for Blaydon (Mr Anderson) made a very important political analysis of the ongoing problems, and my hon. Friend the Member for Nottingham South (Lilian Greenwood) demonstrated her great expertise in this area.
My hon. Friend the Member for Wolverhampton North East (Emma Reynolds) yet again raised the importance of ensuring a long-term solution and expressed our continued regret that this issue was essentially bombed before the last election by the Conservative party, which decided that it was better to make cheap political points than for us all to work together. I assure the Minister that when the Dilnot commission reports we will not be emulating the behaviour of the Opposition at that time and that we will approach the matter with an open mind. We need a fair and sustainable solution, and we want to be able to work together on that. In the end, the issue is more important than party politics, and we must work together not just to find a solution but to implement it.
During the comprehensive spending review, the Government flourished the fact that they were giving an additional £2 billion for social care, but a few months later, local authority budgets were slashed by 8%. Given that social care is top-tier councils’ biggest area of discretionary spending, it was simply inconceivable that it would not be hit.
The Local Government Group and the Association of Directors of Adult Social Services both raised concerns about the implications for social care of the CSR local government settlement, warning that the extra £2 billion was simply not enough to meet demand. They argued that the spending gap during the period was likely to be between £3.5 billion and £4 billion due to increasing demand from our ageing population, which will add another 4% a year to social care costs in upcoming years.
Of course, some efficiency savings can be made, but they will never be enough to meet the shortfall. Personalised budgets and various reforms might be able to save some money, but the Minister should listen to those who know, such as ADASS and the Local Government Group, when they say that they will be billions of pounds short when it comes to social care. In those circumstances, they will not be able to protect the most vulnerable in our society. The much-vaunted £2 billion is simply not enough, especially as it is not ring-fenced. Will the Minister tell us whether the whole £2 billion, half of it or a quarter will be spent on social care? Can he do anything if not all of it is? Furthermore, can he confirm that he does not know whether it will be spent or not?
Not only are the Government cutting back on social care through local authorities under the cloak of localism, they are no longer doing centralised assessment of adult social care provision. In other words, they simply do not know what is going on. It is extraordinary that unprecedented cuts are being made at a time when local authority provision of social care is no longer being monitored, yet the Government steadfastly maintain that there need be no cuts to front-line services.
The Secretary of State for Communities and Local Government said that
“cutting front line jobs and hitting front line services isn’t inevitable—it doesn’t have to be an option at all”,
and the Minister said:
“It is wrong to scare people about cuts. The coalition Government has prioritised social care—the spending review announced significant extra funding for social care for each of the next four years, increasing to an extra £2 billion investment in 2014-15…This extra money means no councils need to reduce access to social care”.
It is simply not good enough for the Minister to put his fingers in his ears and sing “La la la.” The truth is that cuts in social care are being made now. Although he might not know about them, I can tell him, because ADASS, the BBC and I have done surveys. Last month, I surveyed directors of adult social care in England and got 61 replies, representing a 40% response. I appreciate the detailed responses by 27 Conservative councils, 29 Labour councils and four Liberal Democrat councils; that was, obviously, before the last local elections. The responses showed that 88% were increasing their charges, 16% were increasing eligibility criteria and 7% were considering charging more in the longer term. Many were closing day centres and care homes, 54% were cutting the voluntary sector and a further 24% were considering it for the future.
As predicted by everyone who knows, cuts are happening. Councils have not been able to meet increasing demographic pressure, which ADASS believes amounts to £425 million in 2011-12 alone due to the rising number of older people and people with learning disabilities needing substantial support. The ADASS survey shows that, far from increasing spending to meet rising needs, local authorities in England have cut adult social care spending by £1 billion.
We have heard in this debate about the terrible consequences of cuts to front-line services for the most vulnerable in our community. The fact of the matter is that as a result, an elderly woman might no longer get up at breakfast time but at lunch. She might not have an advocate, but we have a duty to ensure that such people are protected. It is not good enough for the Minister to remain in Whitehall saying that there need be no cuts to front-line services. He must listen to the reality of what is going on. Not to address the funding shortages in local authority social care is reckless and wrong.
Funding cuts also mean that local authorities cannot invest in preventive services, so the cuts being made now will have knock-on effects in the long term. If someone does not have a regular visit—if their shopping is not done for them, or if they are not got up in the morning on time—they are more likely to go downhill faster and to end up in hospital. Some 52% of respondents to my survey said that the cuts adversely affected the development of new preventive services. Services that could reduce the need for long-term care and promote independence are among the first to go, but that only increases the strain on health and social care services in the long run.
It is irresponsible of the Minister to continue to say that no cuts need be made to front-line services. Will he admit that he was wrong not to listen to the warnings and to say that front-line services would not be cut? Will he also admit that efficiency savings alone cannot deliver the huge cuts being forced on local authorities? What is he doing to increase the provision of social care now that he has heard the truth about what is going on?
The holy grail, as we all agree, is integration of social care and health, but the difficulty is that the Government are, on one hand, cutting local authorities extensively and, on the other, taking the health service by the ankles, turning it upside down and shaking it hard. Those are not ideal circumstances for the two bodies to integrate properly. The Bill calls itself the Health and Social Care Bill, but it contains precious little social care. There is a great deal of talk about integration, but words are not enough.
When it released the results of its survey recently, ADASS recommended that, as the Government are pausing to reconsider the Health and Social Care Bill, perhaps they might pause long enough to hear the results of the Dilnot inquiry and radically reconsider their plans for long-term care. If they want to be radical on health and social care, that is the area of need. We do not need the fundamentally misguided Health and Social Care Bill as it is drafted. We do not need competition driven into the heart of the NHS. What we need is co-operation and collaboration. We need health and social care to work more closely together.
If the Government are to pause, let them pause and think about that. Let them pause and ensure that, for example, we can keep the elderly out of hospital for as long as possible by allowing social services to provide proper social care, and that once someone is in hospital, they can get out quickly. That is the only fair way to treat people. Frankly, it also saves a great deal of money. If the Government spent more time, energy and resources on solving such issues and a little less on introducing competition into the national health service, we would all be a lot better off. I know that in his heart, the Minister agrees, but he has unfortunately found himself in the difficult position of having to defend this extraordinarily awful Bill.
I may have argued those points when the Bill was discussed in Committee, and I am glad to hear that ADASS now agrees with me in general. I am also glad to hear that the right hon. Member for Charnwood (Mr Dorrell), never one to allow a bandwagon to pass him by, said that the legislation should be rethought:
“A clear commitment should be written into the Bill to achieve full institutional and managerial integration of the NHS and adult social care in England.”
The Select Committee Chair agrees with us as well.
I ask the Minister to reconsider funding and the reality and to give us an undertaking that he will no longer make false claims that there need be no cuts to front-line services and that he will do something about the matter. I also ask that the Health and Social Care Bill be worthy of its name, if it is not killed off completely. It needs major change so that social care can be integrated properly into health care. Worthy words are simply not enough to achieve that.
The Minister of State, Department of Health (Paul Burstow)
It is a pleasure to serve under your chairmanship, Mr Brady. I congratulate the hon. Member for Stockton North (Alex Cunningham) on his luck in securing the debate and on his choice of subject.
I agree with the hon. Member for Islington South and Finsbury (Emily Thornberry) on one point at least, which is that social care is not debated and discussed in this House anywhere near enough. I speak with the experience of 13 years in opposition and as one of the few who has carried the candle for social care and advanced the arguments, which I have heard others make today, on the need to focus on quality and to make sure that we do well by and develop the work force. I shall return to some of those points.
I agree that the long-term reform of our social care system should no longer be deferred to the long term. It requires our full attention now. We need to make sure that, during the life of this Parliament and, I hope, with the assistance of people of good will from all sides, we can secure lasting reform of both the law and the funding arrangements for social care. Our constituents expect no less of us at this time.
The hon. Member for Stockton North began by referring to last week’s march and lobby. A number of constituents lobbied me, and I met several of them at my surgery last weekend to discuss their issues. They have real concerns, to which the Government are listening and want to respond properly. We share a common goal, which is to maximise personal independence to allow people of all abilities to fulfil their potential. That has to be the common goal of both our benefits system and our social care system. It is certainly this Government’s ambition to achieve that.
I do not belittle in any way, shape or form the stories of the lives of individuals and the impacts of decisions made about spending in different parts of the country. The hon. Gentleman has rightly set out those individual and personal impacts. However, I will offer him a reflection on the past 13 years and, indeed, before that. The stories that he has told could have been told and have been told over the past 13 years, during which time we have seen a gradual tightening of eligibility criteria. Indeed, in 2008 the Learning Disability Coalition published a survey that showed that 72% of what were Labour authorities at that time anticipated—indeed, they were budgeting for this—tightening their eligibility criteria for access to services from “moderate” need to “substantial” need or even to “critical” need. I will discuss the reality in a moment.
Although the hon. Gentleman has rehearsed some important points, what I did not hear was a scintilla of humility, a suggestion of any doubt, or a slight recognition that we are where we are at least in part because of actions taken over the past 13 years. It would have been good to hear just a little indication that we are where we are because of what has already happened.
Paul Burstow
In a moment. If the hon. Gentleman will let me make my point, I will be happy for him to attempt to rebut it. There are things that did not happen over the past 13 years. We did not get to a position where we had a clear statutory basis for adult safeguarding. We did not get to a position where we had consistency of regulation, because the regulator was constantly being abolished and reformed. Funding has been inadequate for many years, and we have seen a failure, for various reasons over 13 years, to find a way forward that has secured consent for funding.
Alex Cunningham
The Minister said that I did not show any humility, but I specifically said that the previous Government and others before them could have done much more on social care. I specifically said that, and it is important that that remains on the record. In the past 20 or 30 years, no Government have addressed the fact that so many more older people and so many more young disabled people will require tremendous support. I hope that the Minister will acknowledge that we all need to do this together.
Paul Burstow
Yes; we can build on that point. The Government recognise the importance of social care and the fact that it lets people live independently, which is what it should be about. It should be about enabling people to live well, to be safe, to continue to do things that we take for granted and to be active participants in civic life.
As has been rehearsed in this debate, there are big challenges. There are demographic challenges and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) has outlined some of those facts. The hon. Member for Wolverhampton North East (Emma Reynolds) has rightly said that, while we should be concerned about the challenge, we should not be so concerned as to forget to celebrate the fact that we have an ageing population—a population that is living for longer and, in many cases, living healthily for longer as well. We also have changing societal expectations and a greater expectation of being able to make choices for oneself, to be in control of one’s own life and to be able to have high standards of support to facilitate that. We have financial challenges. We have a structural deficit. For every £4 that this Government spend today, £1 is borrowed, and we are spending £120 million every day on interest charges.
Reference has been made to the survey by the Chartered Institute of Public Finance and Accountancy for the BBC. I have to say that, of the many surveys that have been produced, including that of the hon. Member for Islington South and Finsbury, it is probably the least robust of the lot. There we go—I give the hon. Lady credit that her survey must be more robust than that of CIPFA, which did not provide a great deal of detail and did not ask the right questions. Indeed, those who answered the questions were not all social services authorities, and they included things in their figures that are not part of social care. Even the Association of Directors of Adult Social Services has criticised that piece of work.
On attempting to address and mitigate the impact of the reductions that the Government have had to make in formula grant over the past year, we have strived to mitigate it in those areas with the greatest needs to make sure that we have increased the support in those areas, relative to others.
The hon. Member for Stockton North talked about high mortality figures in constituencies such as his own. Again, we have to dwell on why that is still the case after so many years, why we still have that legacy, why we have to continue to address those challenges, and why this Government, through their commitments in public health and elsewhere, are determined to make progress.
Despite the deficit legacy, we have taken some decisions. Members have forecast that I would refer to them, and I make no apology for that. We set out in the spending review in October how we would ensure sufficient resource in the system to allow decision makers at a local authority level to protect social care, if they decide that that is their priority. We have a good settlement in that context. An additional £2 billion will come to social care by 2014-15, and that money is getting through. In January, £162 million was put into social care via the national health service, which is something that we were asked to do and which we have done to ensure that social care gets additional support. Moreover, there is £648 million of additional funding from April this year. That money is going to social services departments and is being transferred by the NHS for that very purpose. A further £1.3 billion is supporting the transfer of funding for the commissioning of learning disabilities.
Those sums constitute the biggest transfer of hard cash from the NHS to social care ever. It is not only about supporting social care, but about breaking out of silos. It is about using cash to get people to start having those dialogues that are so important to achieve the collaborative behaviour and integration that are essential to delivering better services for our citizens.
On top of that is the £530 million that will come through the formula grant. I will not micro-manage, from this Chamber or my desk in Whitehall, every single social services authority and tell them how to use that money. It must be their decision, based on need, and they are accountable for such decisions.
Emily Thornberry
The Minister has anticipated what I am about to say. First, if money is being transferred from the health service to social care, I presume that it is being done by primary care trusts, which are at the same time being abolished. Is he confident, therefore, that that money is properly accounted for by the Department of Health, given the current chaos reigning within the health service? Secondly, will he tell us how much of the money given to local authorities is actually being spent on social care in the way in which it is supposed to be?
Paul Burstow
The answer to the first question is yes. The answer to the second question is that I will write to the hon. Lady with further detail. However, it is certainly the case that money is being agreed between the NHS and social services for the provision of social care services that support health and underpin prevention.
I would also like to refer to the work of the King’s Fund, which is reputable body that is often cited by Opposition Members. It has confirmed that, if we take into account efficiency savings, there is no funding gap for social care during the spending review period. Of course, the grounds on which some councils have made their budget judgments mean that some have acted to protect social care through innovation and the redesign of services. Other councils have decided to change their eligibility or charging policies.
Reference has been made to the ADASS survey, which shows that social care spending as a share of council spending has increased. The hon. Member for Islington South and Finsbury has referred to savings that local authorities are making. For every pound of savings that will be made from social care this year, 70p is a result of efficiency and doing things differently and only 20p—this is still something that I regret—is a result of actual reductions in service.
Yes, eligibility has been tightened, but that is not new. As I have mentioned, a survey carried out by the Learning Disability Coalition shows that those tightenings in eligibility criteria have been part and parcel of local government decisions for many years. Indeed, the ADASS survey shows that, when this Government came into office last year, 101 local authorities were already limiting eligibility to services to those with “substantial” need. Twelve months later, 116 local authorities are using “substantial” need and just six are using “critical” need. It is worth looking behind those headlines, because some councils are changing the eligibility criteria, but they are reinvesting the savings they make from that decision into preventive services, such as telecare and giving people personal budgets. For example, Southwark council has reviewed the needs of people with learning disabilities and is changing its services through the introduction of personal budgets, supported living and providing more control and dignity. It is saving resources, but it is also giving people a better quality of life.
The hon. Member for Newcastle upon Tyne North described the unacceptable quality of care in some care homes and the inquiry that was carried out by a local broadcaster. She is right to describe some of the shocking stories that she has heard and to decry how older people all too often get relegated in the headlines compared with scandals over the care of children. She talked about the Care Quality Commission and the fact that it has changed its inspection model. I respectfully suggest that the basis for the legislation that introduced essential standards and has led to a more risk-based model for inspection was debated in the House not under this Administration, but under the previous one. We have not abandoned the changes the previous Government started or thrown the whole regulatory framework up in the air yet again and caused chaos, as often happened in the past 13 years. We are trying to ensure that that model delivers.
The hon. Member for Newcastle upon Tyne North asked about skills and training. Those issues were also touched on by the hon. Member for Blaydon (Mr Anderson). The Government are working with Skills for Care, which will produce work force, retention and personal assistance strategies to address the sorts of concerns that the hon. Lady and others have mentioned. I will publish those shortly.
Catherine McKinnell
I want to reassert the point that, regardless of the changes put in place during the past 13 years under the previous Administration, we are moving into unprecedented territory in terms of the funding given to local authorities for supporting social care within the community. That is the context in which some of the changes that we are demanding and requesting today need to be considered.
Paul Burstow
I have rehearsed some of the findings from the ADASS survey, which shows that although the changes are tough, they are not as unprecedented as the past 13 years of experience would suggest.
The hon. Member for Blaydon talked about the mixed economy of provision in social care and lamented the passing of a time when a public service offer was the almost exclusive way in which social care was provided. He harked back to a golden age that has passed and that may never have truly existed. I am not certain whether I heard him describe a solution or route map that would get us back to the past that he hankers after. If he has one, perhaps he would share it on another occasion. He also talked about Southern Cross. As a Minister, I am, of course, only too well aware of the issues with which that company is currently grappling. Above all else, I am concerned to safeguard the interests of the residents who live in those homes. That should be on our minds whenever we talk about Southern Cross and its prospects. We need to ensure that we secure its future for its residents.
Mr Anderson
I agree with the Minister entirely. I also agree that the previous Government did by no means get things right for 13 years, which is also true of other previous Governments. My worry is that we are being railroaded by a cuts-led agenda. In the past, we at least had a safety net of council provision, but that will no longer exist. Therefore, when organisations such as Southern Cross go belly up, there will be no one to pick up the pieces.
Paul Burstow
My point is that when we came into office, 101 local authorities were already limiting access to services on the basis of “substantial” need. We should not pretend that some overarching change is now happening.
Let me move briefly to the question of the future, which was also a key part of the debate. I am under no illusion that although the settlement that we secured for social care is good, it is only a bridge and a sticking plaster in terms of the future. The social care system needs radical reconstruction surgery, and its funding needs be seen as what it is—a big issue. My ministerial mailbag shows that it is one of the biggest matters about which people write to their MPs, who in turn write to me. There is a real and understandable grievance out there about paying for social care. People feel shock and bewilderment, and they are appalled by the current system because, after paying taxes all their lives, they have to pay for care. That leaves a bitter taste in the mouths of both those who use the services and, in many cases, their families.
I agree with the hon. Member for Stockton North that we need to change. That is why the Dilnot commission, which this Government established last year, offers us hope and a way forward. It has been asked to consider whether there should be a fair partnership between the state and the citizen. The prize that we could grasp is peace of mind and a sustainable system for the future. I will ensure that the points made by the hon. Member for Wolverhampton North East are passed on to the commission, so that they form part of its considerations. It is not sufficient to reform funding alone, because we also need a modern statute founded on 21st-century principles of self-determination, reciprocity and responsibility. The current law is a mess: it is confusing; it lacks coherence; and it is hard to understand.
Emily Thornberry
On the issue of confusion, the Minister spoke earlier about the King’s Fund and said that its view is that cuts will not be made to social care. I have just checked that, and I believe that the King’s Fund has said that there will be a shortfall of £1.2 billion by 2014-15.
Paul Burstow
The King’s Fund has stated that but, if one reads on, the document concerned states that if efficiencies of 3.5% are made, there is no need for a funding gap to open up.
On social care law reform, our current legislation is the product of 60 years of piecemeal legislation that looks back to 19th-century poor law principles. A Law Commission report makes 76 recommendations and provides a firm foundation on which we can build. The Government intend to publish a White Paper later this year and to introduce a Bill in the second parliamentary Session.
Our intentions are clear. During the life of this Parliament, we want both the law on social care and its funding to be reformed. We want that reform to be based on a vision in which there is a greater personalisation of social services, a more preventive focus on how those services are provided and a real attempt to deliver around outcomes. We want services that are more innovative and that are based around growth, telecare and involving other providers. There also needs to be a partnership between the individual, the state and health and social care providers. That is how we can secure the future of social care and make a real difference for every one of our constituents. I thank the hon. Member for Stockton North for initiating the debate, and I hope that we will have more debates about social care than have taken place during the past 13 years.