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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.