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The Parliamentary Under-Secretary of State for Health (David Mowat)
I thank all those who have spoken in the debate. This is a serious subject, and we have had a number of serious contributions. I will answer some of the points that have been made, before talking more generally about the Government’s approach to adult social care, both now and for the remainder of this Parliament.
I congratulate the hon. Member for Liverpool, Riverside (Mrs Ellman) on bringing this debate to the Chamber, because this subject matters. If there is one thing on which we can all agree, on both sides of the political divide, it is that the whole care agenda is very important to very large numbers of people. The care industry employs more people than the NHS: it employs 1.5 million people. As the hon. Member for Worsley and Eccles South (Barbara Keeley) said, many of them are not well paid. I think she said that some of them do not get the minimum wage. If she has evidence of that, she needs to come forward with it and we need to prosecute, because that is illegal.
However, it is right to say that 1.5 million people work in social care—more than in the NHS—and that number will grow over the next decade or two decades. Depending on how he gets on in the forthcoming election, the hon. Member for Liverpool, Walton (Steve Rotheram) may find that his responsibility in that regard is increased greatly. As well as those 1.5 million people, to whom we should all be grateful—I do not think I could do that work very well—6 million people across our country give informal care. Of those, some 300,000 are aged under 18. It is estimated that one in 30 people in schools are giving informal care to an adult or sibling. We should all reflect on that, because that number will also increase over the next decade or so.
A number of Members have made the point that the precept raises less in Liverpool than it does in Surrey. The hon. Gentleman said that many more houses are in council tax bands A or B, and the consequence is that the precept will raise less. That is self-evidently true, and the Government accept that. That is why the way in which the improved better care fund is and will be allocated to councils takes into account the moneys that are available from the precept, so that the total is in accordance with the relative needs formula.
There is one thing I want to get absolutely straight. I do not want to spend the next 18 minutes bandying numbers around, and I am happy to write to all the Members here about the numbers that I am about to give. The hon. Member for Liverpool, Riverside correctly said that the Liverpool spend on social care was £154 million in 2015, and she said that it is budgeted to be £130 million by 2020. I think those were the numbers she used. The number that we have in cash terms—I will write to Members with this—is £194 million by 2020. That is a real-terms increase of 18% between now and 2020. I have spent quite a long time with officials today to make sure that those numbers are correct. The amount that Liverpool City Council will receive from the improved better care fund in 2019-20 is £26 million. That dwarfs the amount that the precept will raise.
Barbara Keeley
The Minister said that he does not want to keep on bandying figures about, but as we all know, the difficulty is that the funding that he and the Government keep talking about is back-loaded. The problem is happening now—5,000 people have lost their care packages now, and the problem has been happening since 2010. It is not helpful, in this totally stressed situation, to talk about money in 2019-20.
David Mowat
I was just making the point that the figure the hon. Member for Liverpool, Riverside used was £130 million and the figure I have is £194 million. I accept that that number is not for today, and I also accept, as I have said many times in the Chamber, that the social care system is under pressure throughout the country, and Liverpool is part of that.
Steve Rotheram
I am trying to be helpful to the Minister. I quoted a former director of adult social care in Liverpool, Samih Kalakeche, who said:
“If we don’t do something within the next six months, I believe social services will not exist”
by the time that the Minister believes we will get the additional funding.
David Mowat
Today is not Budget day. I accept that the systems are under pressure. The precept has raised something, and Liverpool’s budget for social care is increasing next year, but it is fair to ask whether it is increasing enough given the pressures we are under—that is a reasonable point. My point about the £194 million figure was in response what was said earlier. Although I and the Government accept that there are pressures, it is important that we share accurate numbers with each other.
The hon. Member for Liverpool, Riverside also made the good point that there is now an increasing tendency for care to be provided in people’s own homes. If we look at the care home market over the past decade, we see that roughly speaking there are the same number of beds today as there were 10 years ago, and that is clearly in the face of a considerable increase in demand. That is because far more people are now being looked after through domiciliary packages in their own home, and that is the market we need to get right and make effective.
The hon. Member for Garston and Halewood (Maria Eagle) raised the potential issue of councils being punished in the Budget for being efficient. I will be very disappointed if that is the case—it is not my understanding of what will happen—but it is a fair challenge, and we will have to see about that when the Budget comes out.
The hon. Lady raised a number of points about the STP. We all share the STP area, and there is work to do on it. I will make this point, however: she talked about cuts of £908 million, but those are cuts against an increase in demand—they call it the counterfactual—of 4% or 5% over the next period. The truth is that Cheshire and Merseyside will be getting real-terms increases in funding for every year up to 2020. Nevertheless, that does not mean that there are not challenges, for some of the reasons we have heard, such as demographics and all that goes with that.
The hon. Member for Liverpool, Wavertree (Luciana Berger) asked for a glimmer of light and hope; hopefully, between myself and the Chancellor tomorrow, we can achieve that. She also raised the cases of Sobia and Veronica and their care packages. It is difficult for me to respond to that, other than to say that the Care Act 2014 set out statutory requirements for what councils need to do. If those statutory requirements are not being met, and the way she described those cases implied that might be the case, that is clearly against the law and there is recourse either to the local authority itself or to the ombudsman. I would be happy to talk to her about that in more detail.
The hon. Member for Liverpool, Walton made a number of points and started by talking about delayed transfers of care. He rightly said that I have talked on a number of occasions about variations between councils in delayed transfer of care performance. I will say that DTOC is not the only measure of the effectiveness of a social care system; it just happens to be one the easier ones that we can get a metric around. The fact is that if we look at the 10% worst and the 10% best councils in the country—Liverpool is round about the middle—the level of delayed transfers differs by a factor of around 20 or 30. I absolutely concede that social care systems work better with more money, but it is not just about money, because that is about different working practices and different people doing things in different ways. It is right that we have the debate about that, as well as about the need for more money.
The hon. Gentleman challenged me to name some councils that were much better than Liverpool in terms of delayed transfer of care, within a similar budget environment. I do not know what the budget environment is, but I have a list I can give him of councils that have fewer delayed transfers of care. As I said, Liverpool is not a particularly bad council, and I do not want to imply that it is, but Durham, Kirklees, Sunderland, Barnsley, Newcastle-upon-Tyne and St Helens all have at least 10 times less delayed transfers of care than Liverpool. I was taken to task at a recent Conservative councillors meeting, in which people said that having a good social services department is not just about delayed transfer of care; it is to do with a whole lot of other things. I absolutely accept that, but in a sense the hon. Gentleman started it, so I wanted to give him those figures.
Steve Rotheram
Will the Minister therefore pay tribute to Liverpool for what it has done and its innovative approach? My question was about councils that have had similar cuts to Liverpool of around 60%. None of the councils that he mentioned has had the same degree of cuts as Liverpool City Council.
David Mowat
The hon. Gentleman mentioned some councils that were in the south and I picked some that were not, but fair enough—I accept his point. He mentioned that, depending on the result of his election, he would have a summit. I would be delighted to attend, if he were to invite me—although who knows where I will be by then.
David Mowat
Indeed. On Thursday, I am going to Liverpool to give a talk at a care conference. I would be very happy during that visit to come along and talk to the council about some of the issues raised here today. As the hon. Gentleman rightly said, I am sure that the Government can learn from Liverpool. Frankly, we can all learn from each other. When I went to Whiston hospital and saw discharges to St Helens and to Liverpool, I saw some wonderful things happening there. Anyway, the offer stands.
Maria Eagle
I am sure that all councils in Merseyside would be happy—I know that Knowsley would—to see the Minister on Thursday if he has a bit of spare time. Does he agree that it will be a bit of a blow if the Chancellor’s reported actions tomorrow reward those with a poorer record with smaller cuts to their resources than Knowsley’s? Knowsley has a good record on delayed discharges, but according to the formulation listed in some of today’s newspapers, it will end up getting very little, if anything.
David Mowat
I thought that I had said that I agree with the hon. Lady that it would be wrong to punish those that are doing better. She mentioned that Knowsley is one of the stronger councils in that regard; St Helens is even stronger. It would be completely wrong if that were the basis of the allocation. Frankly, that is not my understanding.
I want to talk a little about what the Government plan to do on social care. Part of that involves recognising the pressures that exist. One thing that we get into quickly in social care discussions is a debate about adult social care and frail people—people on the borderline between being ill and being old. If they are ill, they are in hospital under the NHS, and if they are not, they are old, and care is either means-tested or provided by the council. That is a difficult area.
One third of the pressure on councils such as Liverpool arises not from older people but from people with severe learning difficulties, autism and disabilities more generally. Over the past decade, thankfully, the health inequality from which that cohort suffers has decreased considerably, and the life expectancy of people in those categories has increased. The cost to local authorities is clearly severe. In addition, the Government are determined to press ahead with a programme called Transforming Care, which came out of the Winterbourne View case. Too many people with severe learning difficulties were in institutions and long-term hospitals, with all that goes with that. We are moving them into communities with the help of local authorities. There is a plan to move some 3,000 people out of institutions—places hopefully much better than Winterbourne View—and into care. All of that creates pressures of the sort that we have been hearing about in this debate, but that does not mean that it is not the right thing to do.
Luciana Berger
Does the Minister acknowledge that those 3,000-plus people should have been moved a lot sooner? According to various reviews, we should not be in the present situation, with too many people still in that type of accommodation who should not be there.
David Mowat
That is a fair challenge. We have a plan, and we are implementing it in that process. Winterbourne View was about seven years ago now. I have met a number of parents of the children affected and there has been a lot of pressure from them to go as far and as fast as we can. I make the point that every one of those facilities is a project of its own in terms of finding other accommodation and putting in place care—sometimes round-the-clock care. To answer the hon. Lady’s question directly, I would like us to go faster, but I think that we are doing as well as could be expected given the starting point. However, it is a fair challenge.
Barbara Keeley
I do not know whether the Minister watched last week’s Channel 4 “Dispatches”, “Under Lock and Key”, which showed some serious cases of young people who were not better off in their institution, a private hospital. It seemed very difficult to get them moved out into the community. I know that it was a different part of the country, but there were young people in that institution from across the country. It is great to have a plan, but we see programmes week in and week out showing failures, as I have highlighted.
Mr Philip Hollobone (in the Chair)
In responding to the intervention, the Minister needs to make his last point.
David Mowat
I beg your pardon. I will finish at 6.15.
I saw the programme, and it gave us great food for thought. It is a Government priority to get those people moved. We have done some 1,500, but yes, there are 3,000 left in places like the one in Northampton, and it is not good enough. It is a long process, and it is not something that any of us from either side of the House can do just by clicking our fingers.
I will now sit down. This has been a good debate. I will write to all Members here with the figures that I have given, because the figures are right. It is fair to have this discussion, but it must be had on the basis of correct numbers. Even with those correct numbers, I accept that some of the pressures that we have heard about exist.