18:59 - The House divided: - Ayes: 200 / Noes: 279 - Question accordingly negatived.
The Secretary of State for Health (Mr Jeremy Hunt)
I beg to move an amendment, to leave out from “House” to the end of the Question and add:
“welcomes the Government’s Spending Review settlement for health and social care, which ensures that the amount of money available to local authorities for adult social care services will rise significantly across the Parliament, and ensures that up to £3.5 billion more will be available by 2020; commends the work and dedication of those in the social care sector; and further welcomes the introduction by the Government of the social care precept which allows local authorities greater autonomy in making decisions about how they best meet their local communities’ needs for social care.”.
I too want to start by paying tribute all those working in the social care system; there are few jobs that are more important to our society. They work with some of the oldest and most vulnerable people in our society, many of whom have dementia. That is a growing population, with the number of over 90-year-olds having increased by more than a quarter. Life expectancy is up by a whole year since Labour left office. While I would like to claim credit for every Government achievement, that is a demographic change and no thanks to this Government. It also places huge pressure on the system. Every older person is a dad, a mum, a grandparent or a neighbour, and Members on both sides of the House, whatever our disagreements, want them to be treated with the utmost standards of dignity and respect.
Jack Dromey (Birmingham, Erdington) (Lab)
There are none so noble as those who care, and they include the Castle Vale carer I met who buys Easter eggs out of her own pocket to give out in her own time to those she cares for. Does the Secretary of State understand the despair being felt by carers who are told that they have only 15 minutes per visit, the despair being felt by those being cared for because they no longer have the contact they once had, or the despair being felt by the family and friends of those who built this country and who now deserve better in the twilight of their years?
Mr Hunt
I absolutely agree with the hon. Gentleman. It is the hallmark of a civilised society that we treat all older citizens with dignity and respect. I totally disapprove of 15-minute visits. I find it impossible to understand how anyone could really look after someone’s needs in a 15-minute visit. I hope that, like us, he is proud of the introduction of the national living wage, which is helping the people who do this very important work. It will help 900,000 people working in the social care system by paying all over-25s a minimum hourly rate of £7.20 from this April.
Paul Blomfield (Sheffield Central) (Lab)
The Secretary of State will know that Ministers have acknowledged that illegal non-payment of the national minimum wage is rife in the care sector. Does he agree that Her Majesty’s Revenue and Customs should publish the results of the investigations it launched two years ago into the six big providers? Where employers are found to be non-compliant in relation to an individual care worker, does he agree that HMRC should carry out a full investigation into that employer to see how widespread that non-compliance is?
Mr Hunt
We are absolutely determined to clamp down on employers who do not pay the national living wage. If the hon. Gentleman or any other hon. Member has any evidence at all of that happening, they should let HMRC know. HMRC has a policy of naming and shaming employers who do not do the right thing and rightly so.
Wes Streeting
It is welcome that the minimum wage will increase and that money will hopefully reach the workers we are discussing. Will the Secretary of State acknowledge, however, that the consequence of the increase is that the precept that local authorities charge residents for social care will be eaten up by the wage increase—even in local authorities such as the London Borough of Redbridge, of which I am still an elected member? What will he do to alleviate the very real financial burden on my local authority and others to ensure that everyone gets the quality of care they need?
Toby Perkins
The Secretary of State is being generous in giving way. He started his peroration by talking about the importance of care for the elderly and he is absolutely right about that. Does he agree that we are also talking about caring for people with learning and physical disabilities? The care debate is often entirely about the elderly, but it is much wider than that.
Mr Hunt
I will give way shortly, but I want to finish my point about the critical role played by care staff. In total, 1.5 million people work in the social care sector, and I want to mention one group in particular: the 90,000 who come from the EU. They do a brilliant job and we value their contribution to the sector.
If the House will forgive me, I want to share one story from early in my time as Health Secretary about an absolutely brilliant manager, who is Polish, of a dementia care home in Swiss Cottage. The people at the home had advanced dementia and many were unable to talk or move, so the atmosphere in the home was challenging to say the least. I asked the lady how she motivated her staff every day, and she said, “If I can get a resident to smile, they won’t remember it the next day, but I do, and I go home with a smile on my face.” The care that was being provided was, to be frank, completely remarkable. This is a moment for all of us to reaffirm what the Prime Minister said today at Prime Minister’s questions: we want these people to remain and we are confident and optimistic that we will be able to get them to remain.
Norman Lamb
I totally share the sentiment that EU workers are welcome in our country and that we must guarantee their future as soon as possible.
Does the Secretary of State ever feel that he is confronted by a pretty fundamental choice? He can either preside over a system that deteriorates with an increasing number of failures of care, which I know he cares passionately about, or he can be the politician in government who confronts that, who works with other parties and who comes up with a sustainable long-term solution. It is one or the other. I urge him to take the latter course.
Mr Hunt
I absolutely want to be someone in this role who confronts poor care and does everything possible to fight for the highest standards. That is exactly why I am doing this job. Poor care comes in different forms and, yes, funding is an issue. As the health and social care system goes through perhaps its most financially challenging period since the founding of the NHS, I particularly want to ensure that we protect the high standards that the right hon. Gentleman cares about.
Andy Burnham
I heard the Secretary of State’s earlier words about EU carers. I am sure that they were genuine, but words are not good enough for them. The longer the Government leave them in limbo, the greater the risk is that they will leave. Our national health service and our care system could not cope with losing all those staff, so what more is he doing? Is he petitioning the Prime Minister for a decision now that will give them leave to stay and properly respects their contribution to our society?
Mr Hunt
With respect to the right hon. Gentleman, with whom I have enjoyed many debates in this House, neither he nor I wanted the Brexit vote to happen, but now that it has, we have to cope with a very changed world. The Prime Minister said that she is confident of getting an early agreement. I hope that what we are saying in this House this afternoon will resonate with people and make them understand just how valued they are.
Several hon. Members rose—
Mr Hunt
I want to conclude the section about the role of social care staff.
Whatever disagreements we have in this afternoon’s debate, I want the message to go out loud and clear to all social care staff that Members from all parts of the House recognise the work that they do, and that they value it and support them to do that work better. That is part of the definition of a civilised society.
Helen Whately
On the point about the need for a long-term sustainable health and social care system, is it not the case that the Secretary of State is driving through work in devolution deals and sustainability and transformation plans, which aim to achieve exactly that—bringing together health and social care to create a much more sustainable system?
Mr Hunt
My hon. Friend is absolutely right. Although this afternoon’s debate is about the social care system, the sustainability and transformation plans are a critical part of the long-term solution for financial efficiency and for improving the quality of care.
I congratulate the hon. Member for Worsley and Eccles South (Barbara Keeley) on introducing this debate, which is the first Opposition day debate that she has led. I also pay tribute to the fact that she has had a long-standing interest in these issues. She has asked me questions about the social care system on many occasions. She was particularly right to focus on the impact on the NHS, which is real, and on the impact on family carers, which is also real. She talked about Susan and about the impact on people who are finding that they are giving more hours of care than they were planning or are sometimes even able to give. That is something of which we must all be aware. She asked me to answer a direct question: do I recognise the scale and seriousness of the issues faced by the social care system? The answer is, yes, I do. I want to try to address, as comprehensively as I can, some of the substantive issues faced in the social care system.
Let me start by saying that, although today’s debate and the majority of the hon. Lady’s comments were around funding, the issue is not only about funding. The hon. Member for Chesterfield (Toby Perkins) mentioned that social care is not just about older people. In 2011, we had the shock of what was uncovered at Winterbourne View by a BBC “Panorama” programme. We have had a number of examples of horrific abuse at care homes. The Ash Court Care Home case in Kentish Town was one that came to light in 2012. The abuse there was filmed by a relative on a hidden camera. Those issues were primarily not about funding, but about cruelty—a strong word—that we have tolerated in our system. We have had some very significant policy responses since then, which are making a real difference. The first is that this Government, under the coalition, introduced the toughest system of care home inspection in the world.
We often talk in this House about the work of the chief inspector of hospitals, but I wish to pay tribute today to the work done by the chief inspector of adult social care, Andrea Sutcliffe, and her team. She has completed the inspection of nearly 90% of care homes and domiciliary care services. It is encouraging that, despite the pressures that we have been talking about this afternoon, 72% of the places that she inspected were good or outstanding. More importantly, the 28% that are not are the 28% that we know about and are therefore able to do something about.
I take issue with the way the shadow Health Minister presented her findings. She said that a quarter of the inadequate places were unable to improve following re-inspection. However, the reality is that more than three quarters of places that got an inadequate inspection did improve, which is a huge step forward from where we were a few years ago when we did not know where those places were and when there was no change happening at all.
John Woodcock (Barrow and Furness) (Lab/Co-op)
The Secretary of State is right to highlight the need to improve standards and the need for a rigorous inspection regime, but—taking on board what his former ministerial colleague, the right hon. Member for North Norfolk (Norman Lamb), said—does he accept that even if every single care home in the country reached the appropriate standard, there would still be a care crisis? There is not sufficient funding in the system to make it work. Will he agree to work with all parties to do what we should have done many years ago—before the general election in 2010, as he will recall—and get a grip on the issue and, as a country and as a House, try to sort it out?
Mr Hunt
I am more than happy to work with people of all parties to come to a sensible consensus. The one thing that unites all the major parties is a commitment to the NHS and social care system. With respect to the other issues, it is not just about rooting out poor care. It is also about something that the hon. Member for Worsley and Eccles South mentioned earlier—giving a career structure to people who work in the care system and giving them recognition. That is why in April last year we introduced the care certificate, which is based on achieving 15 standards. It is a voluntary system, but the CQC inspects against it, so there is a strong incentive for care providers to get their staff enrolled for the care certificate. I pay tribute to the work done by Camilla Cavendish, who did a lot of thinking and had a long-standing interest in this issue in her time as a journalist and at No. 10, and on whose proposals we are basing our work in this area.
Huw Merriman (Bexhill and Battle) (Con)
I am grateful that my right hon. Friend has mentioned the CQC and also touched on wages. When I met the south-east director of the CQC, it was clear that there is an issue of staff not being paid properly and then moving around the care home sector for a small amount of extra money, which is vital to them. Does my right hon. Friend agree that the living wage will stop that occurring and result in more people staying in jobs for longer?
Mr Hunt
That is a very important point. We have heard suggestions that the Government have been about words, not action, but the national living wage will do an enormous amount to help keep people in jobs for longer and help them to start to think about their jobs as a career, with potential progression into other parts of the health and care system, such as nursing. I commend my hon. Friend for the work that he does on this in Sussex.
Mr Betts
The Secretary of State said that the issues in social care were not only about funding, but it seems that funding is the only issue that he does not want to talk about. The Communities and Local Government Committee is taking evidence on social care. We have had evidence from local councils, including Conservative councils, council directors, unions, care providers in the private sector, care receivers, carers, academics and research institutions, all of whom say that there is a funding crisis in social care. Does the Secretary of State think he might just be wrong in being the only person to deny that such a funding crisis exists?
Mr Hunt
With great respect to the hon. Gentleman, I was coming on to talk about funding. I just wanted to make the point that the issue is not just about funding.
I respectfully disagree with some of the suggestions made by the shadow Health Minister in her comments earlier that this is essentially about party political choices, for the simple reason that at the last election, Labour promised less for social care and would have spent less than we are spending. I gently remind Opposition Members that Ed Balls as shadow Chancellor was absolutely explicit in 2015. He said that he would not reverse funding cuts to local government—indeed, he would have made further cuts. Under this Government, those cuts have started to be reversed. Spending on adult social care increased—[Interruption.] These are the facts. Spending on adult social care increased by around £600 million in the first year of the Parliament and is set to increase further because of the spending review, which will mean that up to an additional £3.5 billion can be spent during this Parliament.
Liz Kendall (Leicester West) (Lab)
I am afraid the Secretary of State is living in cloud cuckoo land. My council has to make £55 million of cuts on top of the £100 million it has already made. There is a funding crisis, and we will not solve it unless he admits there is a crisis. He cannot continue to be in denial, and we cannot have a Prime Minister who constantly says that the NHS and social care have the funding they need. We need cross-party agreement on this long-term issue, but, first, he has to acknowledge that there is a problem.
Mr Hunt
I have great respect for the hon. Lady, but Leicester Council actually increased its adult social care budget by 7%. Overall, there was an increase in the adult social care budget last year, and that was made possible by the new social care precept, which is being used by 144 out of 152 councils. That will raise £382 million this year and up to £2 billion a year by 2019-20.
Liz Kendall
My council has had to cut other vital local services to fulfil its statutory obligations. The social care precept will not even pay for the increase in the minimum wage—the council is going to have to move money from elsewhere. The Secretary of State is living in denial. You cannot solve a problem unless you admit there is one. People are willing to work across the House to deliver a long-term solution, but he has to admit that there is a problem.
Mr Hunt
With the greatest respect, I do not know whether the hon. Lady heard what I said just a few moments ago, but I answered very directly what the shadow Health Minister said. Do I recognise the scale and seriousness of the issues? Yes, I do, and I am coming on to explain what I think the solutions are. The point I am making is, yes, the budget—the amount spent on social care—was cut in the last Parliament, as a result of the very difficult economic situation we faced after the financial crisis in 2008, but it is starting to go up again in this Parliament. We need to look at what we can do to try to turn that into a sustainable improvement in the care received by all our constituents.
A crucial point was missing from the shadow Health Minister’s opening speech. There was a suggestion that the issues in social care are essentially caused entirely by decisions made by central Government. We need to salute the efforts made by councils of all colours to deal with the pressures in social care, because those are very tough. Middlesbrough Council, for example, increased its social care budget by 11%—it is the most improved council in England. My own council, Surrey, which is an affluent area, but has a large number of elderly people to look after, has battled enormous odds to expand provision.
However, the fact is that there is enormous variation in the way local authorities have responded to these challenges. If we look at the impact on the NHS, and at the delayed transfers of care that are attributable to social care, we can see that the best councils, such as Peterborough, Rutland, Newcastle and Torbay, have virtually no delays in hospital discharges attributable to social care. That can be compared with Birmingham, Manchester, Reading and Southampton where there are between 14 and 21 days of delayed transfers attributable to social care per 10,000 of population every working day. That is a difference of 20 times between the best and the worst councils, and we cannot say that there is a 20-times difference in funding between the best and the worst councils.
Mr Jim Cunningham (Coventry South) (Lab)
Members have alluded to the fact that local authority budgets are under the hammer at the moment. More importantly—I have raised this with the Secretary of State before—one of the big problems is having the social workers to get people a care package when they leave hospital to go home, and that creates bed blocking, so we are in a vicious circle. The last Labour Government looked at an offer from the then Conservative Opposition to get together and have a properly funded national care service. Why have we not looked at that?
Mr Hunt
The hon. Gentleman is absolutely right to say that the presence of social workers in hospitals is vital in discharging people, but I think he will be quite shocked to know that 50% of all the delayed transfers of care in the entire NHS happen in just 20 local authority areas. There are many places that are doing these things well, even in the current challenging financial circumstances, but there are others that, frankly, could do a lot better.
Overall, what we see is a picture where the best councils have expanded funding and provision. For example, last year, Windsor and Maidenhead increased its spend by 6.4%, and the number of people accessing long-term care is up by 8%. That was a Conservative council, but the Labour council in Doncaster also chose to increase its social care budget by 10%—nearly £8 million—and it is looking after nearly 7% more people.
This is not just about funding; it is also about the speed of health and social care integration and about local leadership. Where such leadership exists, important changes are happening even now. For example, in Cheshire East, dedicated workers are supporting people with early-stage dementia, saving more than £4,000 a year per client in social care costs while improving the service for patients. Milton Keynes is another good example: its innovative pilots have cut delayed days attributable to social care by nearly three quarters.
Others, regrettably, have chosen to cut funding and provision. There are many reasons for that, but the one thing that is difficult to explain to the public is why, at times of such challenge, local authority reserves have increased by nearly £10 billion since 2010. The hon. Member for Worsley and Eccles South made a fair point when she said that there has never been greater financial or operational pressure on all councils. Like the NHS, there is huge pressure, but unlike the NHS, it has not been possible to protect their budget since 2010.
What is the way forward in this very difficult situation? I think that it is a combination of the right financial decisions locally and recognition by local authorities and the NHS that they are part of the same team. That is why, as has been said, the sustainability and transformation plan process is so important.
It is easy to knock a process whereby local areas come together to have yet more meetings, which we are pretty good at doing in the NHS and social care system, and it is also easy to characterise those meetings as secret, but the fact is that people do not want to publish their plans until they are ready, and they will all be published by the end of this year. Many Members on both sides of the House criticised the Health and Social Care Act 2012 because they felt that it did not do enough to promote integrated care, but now we have a process to do that. That is massively important for the social care system, as this is the first time that local authorities are properly involved in NHS planning. Indeed, four of the STPs—namely those for Greater Manchester, Norfolk and Waveney, Nottinghamshire, and Birmingham and Solihull—are headed by local authority leads. On Monday, the head of operations at NHS England told me that there was not one STP meeting that he had been to where a local council was not represented. At the moment, it is a planning process and it needs to be delivered, but planning needs to happen collaboratively. It is a significant change for the NHS and social care system, but it is finally happening.
Robert Flello
So why is it that Stoke-on-Trent City Council tells me that no council officers or councillors have been involved in the Staffordshire STP? Given that it covers the whole of Staffordshire, the more deprived areas of Stoke-on-Trent and north Staffordshire will, in effect, subsidise south Staffordshire, because it has greater debts. Why cannot MPs have input into the plan? It is absolutely disgraceful.
Mr Hunt
Everyone will have input into the plan, but the hon. Gentleman might want to ask his council why it is complaining about pressures on the social care system when it has refused to use the social care precept and raise extra money, which could be desperately used for social care. That would make a real difference to his constituents.
Where councils and local NHS organisations are working together, we are seeing some real financial savings that are having a big impact. For example, Northumberland has saved £5 million through integrated services with Northumbria NHS Trust, and there has been a 12% reduction in demand for residential care as a result. In Oxfordshire, where the local authorities, clinical commissioning groups and trusts are all working together, discharge delays are down 40% in six months, and those due to social care have more than halved.
Karin Smyth
We are having an interesting tour of various councils around the country. I referred earlier to the fact that people have been let down after the 2015 Conservative manifesto, which promised them that they would be secure in their own homes. The proposal to that effect in the Care Act 2014 was postponed because so many councils put pressure on the Government to delay. The Public Accounts Committee has been told that the proposal will be introduced in April 2020. What work is happening in the Department to ensure that that proposal will come forward so that people will be secure in their own homes?
Mr Hunt
We are doing work, and I would simply say that we have also delivered on that promise because we have introduced the deferred payment scheme, which means that no one will need to sell their home because of social care costs.
I will wind up now, because I know that many hon. Members want to speak. When we have local authorities and the NHS working together, what is our objective from that process? We want a seamless transition for patients between the health and social care system. We want shared electronic health records so that patients are not asked the same questions time after time. We want a single assessment system so that people are not assessed twice by different organisations trying to get different results. We want to see the pooling of budgets, we want to get rid of delayed transfers of care, and we want multidisciplinary teams. Most importantly, we want there to be a single plan for every vulnerable person, to which everyone who is involved in their care adheres. Those are the objectives.
In the face of enormous pressure, the best solution for local authorities and local NHS organisations that are finding things challenging right now is not to slow down those vital changes, but to accelerate the pace of change, so that we eliminate waste and improve patient care at the same time. Councils that do so will have the full support of the Government. I urge the House to support the Government’s amendment.
Madam Deputy Speaker (Natascha Engel)
Before I call the next speaker, I will have to impose a seven-minute limit. I have to warn Members that the more interventions that are taken, the more that limit will have to come down.
Andy Burnham
I am very grateful to the hon. Gentleman for his intervention and the spirit in which he made it. He is absolutely right: that set everything back and meant that there was no possibility of a cross-party approach. There will have to be such an approach if we are to fix social care and, indeed, to give the NHS what it needs, because they will both need more funding during this Parliament. That is the real shame. I did not make my point about Andrew Lansley for political reasons; I just want people to understand what happened, so that the current generations of politicians might do something different.
The answers we have since had from the Government are wholly inadequate. We have heard today that the precept does not raise enough money, particularly for poorer councils. It is no answer; in fact, it just cynically devolves the responsibility for the whole issue to local government, even though councils did not create the problem. I still favour an all-in system. I will say it: I favour a system in which we ask older people to pay a set contribution, so that they have peace of mind in later life, with all their care costs covered.
Mr Jeremy Hunt
I am listening very carefully to the right hon. Gentleman. In the spirit of wanting to rise above party politics, will he agree that it was totally wrong of him to suggest at any stage in the last Parliament that the Government wanted to privatise the NHS, when we have never had the intention to do so? It was wholly irresponsible to scare the public about that.
Andy Burnham
In a week when Virgin Care is taking on a huge community care contract, I do not think the Secretary of State should be making that point—particularly the Secretary of State who privatised ambulance services in Greater Manchester. I honestly do not think we need to go there.
The point that I am making is about funding social care. The Conservatives claimed that we were introducing a new inheritance tax. Do people not understand that just 3.4% of estates in this country attract inheritance tax? Why is that? Because the vast majority of estates are whittled down by the costs of care—tens of thousands of pounds, or hundreds of thousands of pounds for some people. That is not fair and it is not sustainable. We must be able to do better.
I feel so strongly about this because I saw my grandmother go through the care system in England 20 years ago and, frankly, it was nowhere near good enough. I arrived here saying that I would do something about it. I tried to do something about it, but we have not got anywhere near a solution to the scale of the challenge. People will need to put party politics aside and find common ground. The point scoring and failure to grasp big issues have led to a situation where people have low regard for this place.
We are left with a malnourished, privatised care system in England that is sinking lower as we speak. A culture of slap-dash 15-minute visits is entrenched, in which staff do not get properly treated, trained or respected. Standards in care homes have slipped even further, and stories of neglect and abuse abound—we hear them all the time. Countless vulnerable people and their families still have to pay these cruel dementia taxes, which have risen under this Government, losing everything they have worked for and going into later life with everything on the roulette table: home, pension, savings—the lot. That is not the care system we should have in 2016 in this country. At what point are we going to say, “Enough is enough,” and actually do something about it?
Mr Jeremy Hunt
Just before my right hon. Friend wraps up, I want to put on record my thanks to him for his outstanding work in my Department, both in mental health and in social care, and for his real commitment to the voluntary organisations and the patients and service users in those areas.
The Parliamentary Under-Secretary of State for Health (David Mowat)
We have had a good debate, with a number of very good speeches from both sides of the House. I will try to respond to the points, or the themes of those points, that have been made.
First, I want to address the accusations, made by Labour Members, of criminal behaviour in relation to the minimum wage not being adhered to. If such evidence exists—I think the hon. Members for Sheffield Central (Paul Blomfield) and for Tooting (Dr Allin-Khan) raised this issue—please bring it to me. I will see that it goes to Her Majesty’s Revenue and Customs. Those involved will be named and shamed. Such behaviour is illegal and is not to be tolerated. I think the hon. Member for Tooting also said she had evidence that a care home or domiciliary supplier was forging attendance sheets. Again, if there is evidence of that I would like it to be brought forward. It should not just be bandied about here in a political way. We should investigate it and we will. If she brings that evidence to me, we will look at it.
One of the big themes in this debate, and one with which Members on both sides of the House can agree, is the importance of carers. The hon. Member for Worsley and Eccles South (Barbara Keeley) spoke about that and, rightly, about the need for a better career structure and clearer training requirements, a point the Cavendish report also addressed. Some 1.5 million people work in domiciliary and care homes, but—this is a very difficult statistic—the annual turnover is about 25%. That is caused not just by poor pay—I am proud to be part of a Government who have increased the pay of many of these people—but by a lack of career structure and, frankly, of regard, and we need to do more on that. She was right to raise it.
My right hon. Friend the Member for North East Bedfordshire (Alistair Burt) made the important point that, as well as the 1.5 million paid carers, there are 1.1 million unpaid carers. In many ways, these are the unsung heroes of the entire system, and we can all agree we need to do better by them. When he was doing my job, he kicked off the carers’ strategy, which we will be coming forward with. It is a cross-Government initiative and will result in concrete actions to make the 1.1 million-strong unpaid carer cohort better off.
Several people talked about finances and money. Of course they are tight. The Secretary of State made it clear that in the last Parliament, in order to respond to the situation we inherited, there were cuts to local government funding. During the course of this Parliament, there will be a real increase in the rate of adult care funding, but that is not to say we do not understand that the system is under pressure. We understand that, as Simon Stevens said, if more money was available, it would be good if it went into the social care system.
Members on both sides of the House spoke about bed-blocking caused by a lack of money, and about delayed transfers of care, and it is true. Of course there is a correlation between the amount of money in the system and the number of delayed transfers of care, but one of the most extraordinary things about the numbers is that, between the best and worst 10% of local authorities, in terms of the number of DTOCs, the difference is a factor of 20 to 25. That is not just about budgets—budgets are not 20 to 25 times different—it is about leadership; about good people doing good work; about spreading best practice; about shared assessments, early discharge and discharge to assess; and about integration in the widest sense, as my right hon. Friend the Member for North East Bedfordshire said. Those councils, local authorities and health systems that have gone fastest and furthest with integration—the holy grail that the right hon. Member for Leigh (Andy Burnham) talked about—are those at the top end of the DTOC statistics. We should all think about that when we say, “We want more money.” We should all think about the reasons for that difference.
I would make another point about finance. An Opposition Member talked about the GDP equation getting worse in this Parliament. That is not true, but I would just make this point: in 2016, the OECD looked at the money spent on adult social care right across the major economies of Europe, and we in the UK spend about 20% to 25% more than other major industrialised countries such as Germany and France. That is not to say that the system is not under pressure in our country—it clearly is—but the facts are that other countries do a better job in terms of long-term saving, social insurance and some of those types of things. We clearly have an issue with this. Let me repeat that Germany and France, which in the round spend more on the entire health system than we do—about 1% more as a proportion of GDP—spend 25% to 30% less on adult social care. It is critical to spend what we can spend better.
Andy Burnham
I hear what the Minister says, but it seems to me that, in common with the Secretary of State, he is avoiding the main issue. The main issue is the urgent financial crisis that councils are facing. They have not got enough money to care for the people who need care. Will the Minister answer a direct question? Has he or the Secretary of State made a submission to the Treasury for more funding for social care as part of the autumn statement—yes or no?
David Mowat
We are not having the autumn statement today, and we are not going to give a commentary on what will come out of the autumn statement. We—the Secretary of State and I—have accepted that the care system is under pressure. I was just making the point that other countries spend less, and that we need to spend every penny we can as effectively and as well as we can. During the course of this Parliament, moreover, there will be a real increase in the amount of spending on social care.
Several hon. Members rose—
David Mowat
Let me make some progress, and I shall give way again later.
Another theme has been closure. Several Members have talked about contracts being handed back, and there is a bit of that going on in both domiciliary care and care homes. Let me put on record the fact that the number of bed places in care and nursing homes is broadly the same as it was five years ago. There has been no reduction. As for domiciliary care providers in the market, the number is now 47% higher than it was five years ago. There has been, rightly, a trend away from care homes to domiciliary care—and we should all welcome that, because people broadly want to spend more time in their own homes. I was asked a good question about the issue of 15 minutes of domiciliary care and what we are doing about the problem. When the CQC is doing its quality reviews, it has a specific question to ascertain whether 15 minutes is the norm, and if so, it would result in a poor quality assessment.
Members have raised broader issues of quality. Let me therefore say that 72% of care homes—a sector that is under a great deal of stress—are good or outstanding. This Government have been the first to do any kind of inspection to find that out. Of course some care homes are inadequate. As the Secretary of State said, inadequate care homes go into special measures and can be closed down after six months. That is the right thing to do, and we should be pleased and proud that that happens.
Also, users of care homes have been asked whether or not they are satisfied, and just under 70% said that they are either extremely satisfied or very satisfied with the level of care provided for them. Members of all parties should come together on this point and thank the people who work in these care homes for the dedicated care and the humanity that they provide.
The former Minister, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who is no longer in his place, talked interestingly about the vanguards, the STPs and what we are doing to bring in leading-edge better care models. A lot of work is being done on the STPs, and I heard a couple of Opposition Members say favourable things about their STPs.
The hon. Member for Halton (Derek Twigg) asked me a number of specific questions about his STP. I will probably not have time to answer in detail, but I can say this. His STP and my STP are the same, and it is being published today—[Interruption.] It is certainly not secret, and we should have some dialogue about it. The hon. Gentleman made the point that his council was under pressure, and councils are under pressure. I think we should join together to congratulate both Halton and Warrington Councils on being two of the best performing councils in the country on delayed transfers of care and on increasing their budget.
I finish by—