(7 years ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Barbara Keeley (Worsley and Eccles South) (Lab)
I beg to move,
That this House notes the Conservative Party’s manifesto commitment to a funding proposal for social care which would have no cap on care costs and would include the value of homes in the means test for care at home; further notes that this proposal would leave people with a maximum of only £100,000 of assets; calls on the Government to confirm its intention not to proceed with this commitment; and further calls on the Government to remove the threat to withdraw social care funding from, and stop fines on, local authorities for Delayed Transfers of Care and to commit to the extra funding needed to close the social care funding gap for 2017 and the remaining years of the 2017 Parliament.
After the debacle of the dementia tax, there has been continuing concern that the current and future issues about the funding of social care are not being addressed. The worries stirred up by the Conservative party during the general election will not be resolved without a better idea about what the future now holds for social care.
One place where people were expecting to hear some discussion on this was at the party conferences in September, but if we thought that we would hear about it in the conference speeches of the Secretaries of State responsible for social care, we were sadly let down.
At the Labour party conference, I talked about the crisis in social care and how it was failing those who need care and their families, failing unpaid family carers and failing hundreds of thousands of care workers. People needing care and their carers face the greatest impact. Since the Conservatives came to power in 2010, there are 400,000 fewer people receiving publicly funded care and, sadly, more than 1.2 million people now living with unmet care needs, many of whom are isolated and lonely.
Kelvin Hopkins (Luton North) (Lab)
My hon. Friend is raising a very important issue, which is leading to a lot of suffering among elderly people in particular. Will she make reference to the Royal Commission on Long Term Care for the Elderly, which, almost two decades ago, recommended free long-term care for all? That is where we should be.
Barbara Keeley
I will talk about how the Labour party will take forward proposals on the future of social care. We wait to hear what the Government choose to do. My hon. Friend is right that there is a driving need now.
The number of people—1.2 million—living with unmet care needs will inevitably rise without an injection of new funding. A lack of publicly funded care means that the task of meeting care needs falls more heavily on unpaid family carers. Many carers have to give up work because of the demands of caring, which has a real impact on their finances and future career prospects. The case for listening to carers and giving them more support is overwhelming. We were expecting a new carers’ strategy this spring, or, at the latest, in the summer. Some 6,500 carers had taken the time over and above their caring responsibilities to respond to the Government’s consultation. However, the Care Minister told me that the responses will merely be taken forward into a new consultation on social care.
Katy Styles, a carer and a campaigner for the Motor Neurone Disease Association, contributed to that consultation and hoped that her voice would be heard, alongside 6,500 other carers. She told me:
“Not publishing the National Carers Strategy has made me extremely angry. It sends a message that carers’ lives are unimportant. It sends a message that Government thinks we can carry on as we are. It sends a message that my own time is of little worth.”
That is a shabby way to treat carers—the people who provide more than 50% of the care in this country.
Kevin Hollinrake (Thirsk and Malton) (Con)
The hon. Lady refers to unpaid carers. Labour’s motion references the Communities and Local Government Committee report on adult social care, which looked at the German system of social insurance. Under that system, payments are made to family members to remunerate them for that care. Has she read that report, and is it something that she is willing to look at in further detail on a cross-party basis?
Barbara Keeley
I will come on later to discuss how we should proceed and whether we should proceed on a cross-party basis. The hon. Gentleman’s point about carers and family carers is important. The plain fact of the matter is that there was nothing for carers in his party’s manifesto. We had announced that we were going to lift carer’s allowance at least to the level of jobseeker’s allowance. That is the only improvement that was discussed during the general election. He should turn to his own Minister and his own party and ask them what they will do for carers.
Mr Mark Harper (Forest of Dean) (Con)
I welcome the hon. Lady’s tone in this debate. It is very valuable. I know that she has taken an enormous interest in this subject, even when it has not fallen within her Front-Bench responsibilities. These debates are very helpful in educating people about difficult issues. I am happy to accept that we did not handle this issue well in the general election. The mistake that we made was not being clear about the current system, which is why her reference in the motion to our proposal without setting out the current system in which people can potentially lose all but £23,000 of their assets is disappointing. Such information would have helped to contribute to the public debate.
Barbara Keeley
We will come on to that. If the right hon. Gentleman wants to get into the mess that his party made, the truth is that we legislated a number of years ago to lift the asset floor to £118,000. What his party did during the election was drop that to £100,000. At the weekend, we learned that there was an intention to make it only £50,000. He should be clear about what his Front-Bench colleagues were trying to do. Since then, all we have heard is a deafening silence.
We need to focus on the crisis in social care now. We on the Labour Benches have raised many times just how fragile the care sector is after years of swingeing budget cuts by the Government. A survey by the Association of Directors of Adult Social Services reported that more than two thirds of councils had reported closures of care providers in the first five months of the financial year. Nearly half those councils had had homecare providers handing back contracts.
Kelvin Hopkins
My hon. Friend refers again to local authority care homes. In my constituency, three superb local authority care homes were forcibly closed effectively by Government policy. They were loved by the residents. They had full-time, permanently employed trade union staff and were supported and applauded by the local healthcare professionals. They were all closed. Now we have only the private sector, which is in crisis.
Barbara Keeley
It is very important that we bear in mind that the 1.45 million workforce in care will have been local government employees and will have enjoyed local government terms and conditions. We have talked many times about the fact that they are not now paid the minimum wage or travel time. They are very badly paid, with no pensions in prospect.
Kate Green (Stretford and Urmston) (Lab)
As my hon. Friend knows, in my constituency, which neighbours hers, we have a real problem in recruiting and retaining care workers, many of whom tell me that they can get better paid work in the local Asda than by doing the job that they love. Does she not agree that that is in part due to the fact that private providers, who would like to pay their staff more, cannot do so because of the insufficiency of the value of the contracts that they receive from the local authority?
Barbara Keeley
That is absolutely the case. In fact, in a recent meeting with Unison, I was told that, in our area in Greater Manchester, one person could be paid more for putting toppings on to pizzas at Morrisons than for providing care—often to people with dementia or to those who really need that help.
Huw Merriman (Bexhill and Battle) (Con)
The hon. Lady talks about a squeeze in funding. On that basis, does she agree that it would be right to ask those who do have the means to contribute more towards their social care in the home?
Barbara Keeley
No, I do not agree with the hon. Gentleman. That is one of the reasons why his party’s dementia tax policy failed so badly. Suddenly to bring hundreds of thousands of people into means-testing using their homes was one of the biggest flaws in the policy that the Conservative party floated.
I will now make a little bit of progress on the state of care, because the fragility of the care sector is a key issue. We heard from my hon. Friend the Member for Luton North (Kelvin Hopkins) about closures in his area, but councils cannot even influence these closures much any more because home care providers are handing back contracts. Indeed, one in five councils in the ADASS survey reported closures in all three services: home care, residential care and nursing home services. There are also serious issues of care quality in many areas of the country.
The survey reported that 70% of the councils surveyed had experienced quality issues across all three types of care services. ADASS estimates that 28,000 people have been affected by care-quality issues or by a change of service due to contracts being handed back. We know that it is a big issue for a person with dementia to have a continual change in the care staff visiting them. Those arguing in favour of cuts need to think about those 28,000 lives affected negatively by cuts to local authority budgets. Worryingly, the Care Quality Commission now reports that almost a quarter of care services are not meeting standards on safety, and nearly a fifth of services require improvement overall.
I said earlier that budget cuts mean that more than 400,000 fewer people are now getting publicly funded care. Of course, councillors, council leaders and social workers have had to make difficult decisions about cutting budgets and cutting support to local people. It is of great credit to councils and council leaders that so many still continue to prioritise adult social care in their budget setting, but the overall position is one of cuts. There will be a real-terms loss of £6.3 billion to adult social care by the end of this financial year, and we heard earlier from my hon. Friend the Member for Manchester, Gorton (Afzal Khan) about the level of cuts in the city of Manchester. The cuts have an impact on staff working in social care.
Jack Dromey (Birmingham, Erdington) (Lab)
At last, the Government and Her Majesty’s Revenue and Customs have acknowledged that care workers who sleep in, giving loving care to those badly in need of care, are entitled to the national minimum wage. But, as a consequence, a crisis confronts the sector. Mencap says that it is the
“final nail in the coffin for many providers”,
with jobs lost and the risk of bankruptcy for a number of people with personal care packages. Does my hon. Friend agree that the Government who created this problem should solve this problem and not expect local authorities to pick up the bill?
Barbara Keeley
I absolutely agree, and it was helpful of my hon. Friend to make that point. The sleep-ins issue has been a real cause of worry for many organisations over many months. It just goes to the heart of our assertion that people who work in care should be paid the minimum wage, including when they are working at night, which is what they are doing on sleep-ins. I have a constituent who looks after two households of people in adjoining properties, and she does not get normal sleep during the night as alarms can go off in any part of the properties. It is not right at all that those people were paid just fixed amounts, not the minimum wage. The Government must find the funding for that decision.
Kelvin Hopkins
I do apologise for intervening so often. Does my hon. Friend agree, as my hon. Friend the Member for Birmingham, Erdington (Jack Dromey) has hinted, that the whole care sector ought to be in the public sector in the longer term at least, provided on the same basis—free at the point of need—as the national health service?
Barbara Keeley
As I said earlier, I will come to our proposals; I do not want to jump around in my speech too much more.
Going back to staff working in social care, it is important to remember and think about social workers, not just care staff. A recent study found that less than half the social workers surveyed felt that decisions about a person’s care and support were being left to their professional judgment; it is now all about budgets. More than a third said that they had felt unable to get people the care they need. Less than half felt supported to have necessary difficult conversations about changes to care with people needing care and their families.
The social care crisis is a direct result of the cuts that this Government have chosen to make. The King’s Fund, the Health Foundation and the Nuffield Trust estimated that there would be a funding gap in social care budgets of £1.9 billion for this year, but the extra funding in the Budget was only £1 billion, so there is still a funding gap of £900 million this year. Labour pledged an extra £1 billion for social care this year to start to deal with that funding crisis. However, the Government have chosen instead to put the pressure on local authorities and hard-pressed local council taxpayers to deal with that social crisis, which was made in Downing Street.
Delayed transfers of care due to social care cuts increased by more than a quarter in the 12 months to August this year, putting extra pressure on local councils. Now, sadly, Ministers are threatening councils with fines and further funding cuts to social care if targets for cutting delayed transfers of care cannot be met. Indeed, ADASS reported that half the social services directors it surveyed believe that their targets for delayed transfers were unrealistic. It is barely believable that the Government’s response to the social care crisis is to threaten to make the situation worse by cutting funding for social care even further. Some councils experiencing problems meeting targets were even summoned by NHS leaders last week to a meeting to review their performance challenges.
Many people have said that the approach of blaming and penalising local councils is not sustainable. The Conservative chair of the Local Government Association, Lord Porter, said of the warning letters sent from Ministers to councils:
“No council wants to see anyone stay in hospital for a day longer than necessary. These letters are hugely unhelpful at a time when local government and the NHS need to work together to tackle the health and social care crisis.”
The president of the ADASS, Margaret Willcox, has described the Government’s actions in threatening councils with further sanctions as, “frankly bizarre”. David Oliver, who is clinical vice-president of the Royal College of Physicians and a geriatric consultant, said about delayed transfers of care:
“Some of these delays are due to systematic cuts to social care budgets and provision. Others are due to a serious lack of capacity in community healthcare services…attempts to solve the problem through initiatives like the Better Care Fund or pressure from NHS England have failed”.
Interestingly, Andrea Sutcliffe, the chief inspector of social care at the Care Quality Commission, said:
“I worry that if people focus just on moving people through the system quickly then does that mean that they will force the discharge of somebody that is old and frail into a service which we have rated ‘inadequate’”.
We now have a Government who are driving the NHS to be obsessed with dealing with delayed transfers of care, seemingly above all else. This obsession causes further problems if patients are discharged without planning what they need outside hospital.
Age UK give an example that was brought to it:
“Terry’s father Richard, 85, is in hospital following a stroke. He is ready for discharge and has been assessed as needing rehabilitative care through two home visits a day. However he was then told that there are no reablement services available in his area. Terry has been told to ‘get his father out of hospital’ and to look for and fund the care himself.”
My own local hospital, Salford Royal, sadly seems to have similar issues. Last week, I spoke to a constituent who described her own discharge by saying, “I was thrown out of hospital.” Having had surgery for an infected bite that caused sepsis and a hand that she could not use, my constituent was given no discharge summary, no advice on how to manage her wound and no advice about her recovery. When she struggled to get dressed, she was told that she had to get out quickly, otherwise, “This will count as a failed discharge.” This a theme we may remember from last winter.
I remind the Minister that the British Red Cross talked then of a humanitarian crisis whereby people were sent home without clothes or into chaotic situations. Those chaotic situations involved them falling and not being found for hours, or not being washed because there were no care staff to help them. Ordering patients out of hospital when there is no reablement service for them, without advice about wounds or recovery, or to a care facility rated as inadequate just to meet unrealistic targets on delayed discharge is a recipe for an even worse crisis this winter.
Huw Merriman
The social care and hospital budgets have been merged in East Sussex, where my constituency is. As a result, the A&E is now the fastest-improved A&E department in the whole of England. That change is working. Would the hon. Lady’s local authority consider the same model?
Barbara Keeley
My local authority has the most advanced example of an integrated care organisation in the country—we have already transferred all our social care staff to work for Salford Royal. I have just quoted a situation that shows how the pressure being put on hospitals because of delayed transfers of care is causing them to treat people such as my constituent in the way I described. Conservative Members ought to listen to that, because it is their Government and their Ministers who are causing this pressure to be put on hospitals.
We know that demand on social care is increasing as more people live longer with more complex conditions. The number of people aged 75 and over is projected nearly to double by 2039. That ought to be something to celebrate, but instead the Government have created fear and uncertainty for older people by failing to address the health and care challenges raised by those demographic changes. Indeed, the Conservative party is spending less money on social care now than Labour was when it left office in 2010. The Government seem to have no plan to develop a sustainable solution to the funding of social care in the longer term; they have talked only of a consultation followed by a Green Paper.
Furthermore—and this is raising real fears—the focus has been entirely on the needs of older people, without consideration being given to the needs of the 280,000 working-age people with disabilities or learning disabilities in the social care system. That is profoundly short-sighted, because the financial pressures on local authorities due to the increasing care needs of younger adults with disabilities or mental health problems are now greater than those due to the need to support older people.
Kate Green
I am glad my hon. Friend has mentioned younger adults. Does she agree that investing in the care they need will facilitate the Government’s achievement of their ambition to have more disabled people who can work in paid employment? Relatively low levels of expenditure on care for those people would pay great dividends for the Government and the country.
Barbara Keeley
Very much so. I thank my hon. Friend for making that point. It is concerning that planned consultations or discussions about future policy should focus so much on older people, when the needs of people with disabilities and learning disabilities are so important. We talked about learning disabilities in a debate last week.
Labour will fill the policy vacuum that exists around social care under this Government. Over the coming months, we will consult experts on how we can move from the current broken system of care to a sustainable service for the long term. We will look at funding options for social care in the long term, such as wealth taxes, an employer care contribution or a new social care levy. Those experts will help clarify the options for funding our planned national care service. Our approach will be underpinned by the principle of pooled risk, so that no one faces catastrophic care costs as they do now or as they would under the Conservative party’s dementia tax.
Our plans are for a national care service. They are based on a consultation—the “Big Care Debate”—that involved 68,000 people. People in that consultation told us that they needed a system that will support them and their families to live the lives they want, that will treat everyone with dignity and respect and that will give them choice and control over their care. I believe those needs remain the same, and they will be at the heart of our ambition for social care.
I urge hon. Members from all parties to vote with the Opposition today so that we can set the foundations for a safer, more sustainable and higher quality care system for the future and reassure those who have become worried about the Conservative party’s dementia tax mess.
Craig Mackinlay (South Thanet) (Con)
I am always very impressed by the hon. Lady’s knowledge in this area, but just to clarify, did I hear her say that she was considering wealth taxes as a means to pay for these proposals? She talked about a policy vacuum, but I would be interested to hear how the money vacuum would be filled. I am also somewhat concerned—I hope she will explain this—that a national care system rather puts families aside.
Barbara Keeley
I am obviously coming to the end of my speech, but I recommend that the hon. Gentleman, if he is interested, read a number of documents. The Labour Government produced a White Paper for a national care service; it is still available, and I advise him to look at it. Given everything I have said about carers in this speech, there is no way that we would not include them as an important part of our proposals, but the burden should not just be dumped on them. Carers should be partners in care, and they should be supported so that they have a life of their own. It is said that the only numbers put on the Conservative party’s proposals for a dementia tax in its manifesto were the page numbers. The Labour party has produced the document I have here—“Funding Britain’s Future”—and a fully costed manifesto. If the hon. Gentleman has a bit more time for reading, I advise him to go to our manifesto and to look at how we laid out the options. We laid them out; we did not get into a mess, as the Conservative party did, and try to change things after four days. We will take this issue forward; we will not kick it into the long grass, as the Conservative party is trying to do.
Barbara Keeley
No, I am just going to finish.
Our motion asks for action to make sure the care sector gets the urgent funding it needs to prevent collapse. It would also ensure that hard-pressed councils are not penalised for failing to meet unrealistic targets for delayed transfers of care.
The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
I am grateful for the opportunity to respond in this debate. It gives the Government an opportunity to set out exactly where we are in this space—and the position is not as characterised by the hon. Member for Worsley and Eccles South (Barbara Keeley). The hon. Lady was characteristically challenging, and I hope to answer some of the questions she raised. I have some sympathy with some of her messages, and I hope through my remarks to reassure her on some points.
No speech on this issue should start without paying tribute to everyone who works in social care—from the care assistants, managers of care businesses, occupational therapists, social workers, nurses and trusted assessors to the many officials in local authorities who organise care packages and adaptations for people’s homes. [Interruption.] As the hon. Member for Oldham West and Royton (Jim McMahon) has just said, the number of people is increasing.
Jackie Doyle-Price
They all have the best of motivations in providing care, and we should celebrate the work they do to support those who find themselves in vulnerable situations across our society. I would like all of us to recognise the excellent work they do.
The quality and provision of care has been hitting the headlines even more than ever recently. It is therefore reassuring and humbling to see the care and support sector respond with such resilience, commitment and compassion. I was delighted to see that the Care Quality Commission has rated 80% of social care settings as good or outstanding.
Rebecca Pow (Taunton Deane) (Con)
I thank the Minister for raising that issue, because we should not be so negative about this area. The latest report from the Care Quality Commission said that four out of five institutions offer good or outstanding service. In my constituency, I recently visited Abbeyfield to celebrate its 30th anniversary. Its staff are well paid and they love their jobs, and the people there were very happy. Somerset Care has some excellent institutions, and Cream Care was recently rated outstanding for its services. I took the Secretary of State for Health to visit it relatively recently. Our old people in Somerset need to know that that is the kind of care they can have, and this Government are facilitating it.
Jackie Doyle-Price
My hon. Friend highlights just some of the many examples up and down the country, but we should not be complacent about the 20% of settings that require improvement, and there will be lots of work we can do to raise the standard in them. That includes, not least, the work we are doing in collaboration with the voluntary sector and the Local Government Association to spread examples of good practice and quality. We will obviously continue to do that.
We should also celebrate the other good work going on around the country. In just one year in Sutton, for example, even though the number of beds for care homes supported by GPs in the clinical commissioning group increased by 14%, there was an overall reduction in care home residents attending. That is because the CCG has stepped up to the challenge and has better co-ordination of care, enhanced training of care staff and better health care support for older people in care homes. That shows that, with collaboration, we can get better care standards. Social care therefore continues to be a key priority for the Government.
Jack Dromey
The Minister is right to say that there are none so noble as those who care. However, may I press her on a specific issue? The care sector is facing a disaster as a consequence of having to pick up a £400 million bill because of the confusion in the ranks of Government, and likewise in HMRC, with regard to the entitlement to the minimum wage of those who sleep in. Can she say today that that burden, which was not the creation of the care sector, will not fall on local government and that instead the necessary funds will be met by central Government?
Jackie Doyle-Price
The hon. Gentleman raises an extremely important point that I am actively thinking about. He is absolutely right in the sense that providers have been following guidance that has changed. It is clear from our perspective that employers are obliged to meet their obligations under minimum wage legislation, but I am very clear on the challenge that that is giving to the sector, and we will work with it to develop a solution.
Turning to the substance of the motion, we announced in the Queen’s Speech that we will work to address the challenges of social care for our ageing population and bring forward proposals for consultation to build widespread support for future provision.
Judith Cummins (Bradford South) (Lab)
At least 60% of those receiving social care in the home and 70% of those in care homes are people living with dementia. The underfunding of social care has meant that the burden falls disproportionately on those people. Does the Minister agree that whatever the system of social care provided, it is unacceptable that those living with dementia, and their families, should be disproportionately affected?
Jackie Doyle-Price
I invite the House to reflect on what the hon. Lady has said, because that is exactly the issue that we really need to tackle. One in 10 people face very significant costs that they have to meet from their own resources, with only 14,000 ultimately protected. She is right to point out that the vast majority of those people are suffering with dementia and Alzheimer’s. We have now reached a time when it is critical that we have a consensus on the future funding of social care so that we can address the injustice that she has very ably highlighted.
Sir Desmond Swayne (New Forest West) (Con)
Am I right in thinking that under current statute law, a cap of £72,500 will apply from the financial year 2021-22, and that if that settlement is to be altered, it will require primary legislation in this Parliament?
Jackie Doyle-Price
My right hon. Friend is indeed correct.[Official Report, 3 November 2017, Vol. 630, c. 3MC.]
The ageing population presents one of our nation’s most profound challenges. It raises critical questions as to how, as a society, we enable all adults to live well into later life, and how we deliver sustainable public services that support them to do so.
Mr Harper
In a spirit of cross-party consensus, may I add my support to the issue raised by the hon. Member for Stretford and Urmston (Kate Green) by urging that when we bring forward our consultation we cover the nearly 50% of social care spending that is spent on adults with disabilities? I share the view that we must make sure that they are properly supported and able to live full lives, including, where they are able, moving into work. That sometimes gets lost in the debate when we completely focus on people towards the ends of their lives. We must deal with everybody. The hon. Lady made a really important point.
Jackie Doyle-Price
I could not agree more. I share my right hon. Friend’s support for the hon. Lady’s comments. There are still many opportunities to get working-age adults with disabilities into work. We have set ourselves a target of getting 1 million more people with disabilities into work, and we are very committed to doing that.
In response to the point made by the hon. Member for Worsley and Eccles South in her opening remarks, yes, much of the debate has focused on how we care for the elderly, but, as she and the whole House will be aware, support for working-age adults is becoming an increasingly big proportion of local authority spending in this area, and it is very important that we focus on it. Alongside the preparations we are making for consultation in the new year, we have a parallel work stream looking specifically at working-age adults, because some of the solutions will be similar and some will be different.
Barbara Keeley
It is very important that we have got to this point today, because very many organisations and individuals have been worried for months about that. In the Queen’s Speech and in letters the Minister has sent to me, the talk has been of a consultation on social care for older people. The wording needs to change if that is to encompass, as it should, working-age people with disabilities or learning disabilities. Let us stop focusing just on older people. If she would stop doing that in letters and we could have clarity on this, it would be helpful. I also wonder why there has to be a separate work stream.
Jackie Doyle-Price
There needs to be a separate work stream because it is connected to the desire to get more people into work, but the two programmes are working in parallel. As I said, today is a great opportunity to get that on the record. Certainly, it has been very much a focus of my conversations with voluntary groups in the sector.
Mr Harper
Picking up the point about the work being separate but parallel, in thinking about how we are going to fund the care, it is really important to make sure that we do not inadvertently put in place any barriers to work, whereby somebody would find that moving into work would increase the cost of their care to the extent that working was of no consequence. That would not be an issue of funding care for older people, where there are some different challenges. A separate but parallel structure may well be the right one to go for.
Jackie Doyle-Price
Again, I agree with everything that my right hon. Friend says.
To reassure the hon. Member for Worsley and Eccles South, we will have plenty of opportunity to discuss all these issues in the new year. We want to progress this by building a real consensus, because it is a strategic challenge facing us all. Not only are we all living longer, but working-age adults with disabilities are living longer. That is a matter for celebration, and we must do everything we can to make sure that we can meet all our obligations to them.
Kate Green
I am glad that we are spending time on this subject. The Minister will recognise, I am sure, that for working-age adults, relatively modest amounts of care may enable them to participate more fully in the workplace and in wider civil society. Will the separate but parallel work stream acknowledge that? I fear that there will be pressure just to look at the most severe and critical-level need, meaning that many people who could work with a small amount of help will be shut out of doing so.
Jackie Doyle-Price
I could not put it better myself. Necessarily, the system will always focus more on those with the most need, but, as the hon. Lady says, we can get a lot more return from putting in good value for money measures that will support people to live independently and to be able to work. I am very keen to explore those areas.
Jackie Doyle-Price
I will take one more intervention, but I really do need to make progress.
Tracy Brabin
I thank the Minister for giving way. Can she give me some advice for my constituent—a mother with a daughter who is quite disabled with epilepsy? When the mother was retiring, she realised that she would lose her carer’s allowance as she went on to the state pension. When she rang HMRC and the Department to inquire, they said, “By your age, they are normally shoved into a home.” Can the Minister give me some advice on how I could support my constituent?
Jackie Doyle-Price
I am not very impressed by the tale that the hon. Lady describes, but I would like to look into it more directly and get back to her.
The Government have already invested an additional £2 billion to put social care on a more stable footing and alleviate short-term pressures across the health and care system. However, further long-term reform is required to ensure that we have a sustainable system for the future—one equipped to meet the challenges of the increasing numbers of people with care needs. To address these questions, the Government will work with partners—including those who use services, those who work to provide care, and all other agencies—to bring forward proposals for public consultation. The consultation will cover a wide range of options to encourage a very wide debate. It will set out options to improve the social care system and put it on a more secure financial footing, supporting people, families and communities to prepare for old age, and it will address issues related to the quality of care and variation in practice. It will include proposals on options for caps on overall care costs and means-tested floors. It is, however, a consultation, and the Government wish to approach the future of social care in the spirit of consensus. Our consultation is designed to encourage a grown-up conversation in order that society can rise to this challenge.
Kevin Hollinrake
The Minister refers to a number of options that the Government will consider. Will they also consider the suggestion contained in that Select Committee report of a system of social insurance, which would be sustainable and simple and would deal with some of the points raised about adults of working age with learning disabilities? The scheme would cover all those things and provide protection for people who are on low incomes. It seems to work very effectively in Germany, where it garnered cross-party support when it was introduced.
Jackie Doyle-Price
I agree that we want to learn from examples in other countries. As I have said, the spirit of the consultation will be to allow a well-informed debate, as a result of which consensus can be established. In view of that, we will consider a wide variety of options, covering not just funding but lifestyle solutions and other issues.
Jackie Doyle-Price
I must make some progress, because I have taken many interventions. I do apologise.
Adult social care funding is made up of Government grant, council tax and business rates. The better care fund, which was announced in 2013, has further helped to join up health and care services so that people can manage their own health and wellbeing and live independently in their communities for as long as possible. The 2015 spending review introduced an adult social care precept that enabled councils to raise council tax specifically to support social care services. By 2019-20, that could raise up to £1.8 billion extra for councils each year. As a further boost to social care, the Chancellor announced in the Budget earlier this year that local authorities in England will receive an additional £2 billion for social care over the next three years. This year, £1 billion has been provided to ensure that councils can fund more care packages immediately. The additional money means that local authorities in England will receive an estimated increase of £9.25 billion in the dedicated money available for social care over the next three years. Statistics produced today show that spending on adult social care increased in real terms last year by 1.5% thanks, in part, to the precept.
Barbara Keeley
This is an important point. Our motion mentions the need to close the funding gap, which is not £1 billion but £1.9 billion. So £900 million is still not covered, and that is what councils are struggling with. The Minister makes the point about extra funding being raised from local taxation. Does she accept that there is still a funding gap, which means that people cannot be paid the national living wage? We are going to struggle all the way through winter unless the Government accept the existence of that gap and work to close it.
Jackie Doyle-Price
I do not accept that. Let us recognise that this has been hard in the past. We have made money available in recent years, but we know that local authorities have faced challenges. As one local authority put it to me, however, austerity has been the mother of invention, and I congratulate local authorities on the efforts that they have made. [Interruption.] That came from a local authority leader, and I agree that local authorities have shown considerable initiative by implementing savings. As for the national minimum wage, it is enforceable, so I do not accept the hon. Lady’s point at all.
Barbara Keeley
Does the Minister accept that the Government are providing less funding for social care than they were in 2010? She can check that with NHS Digital. The funding is less in real terms. It does not matter that it has increased this year because of the social care levy; it is less. Given the complexity of the issue and the growing demographic challenge, it is clear why we have this gap.
Jackie Doyle-Price
I think it matters a great deal that we have made £9.25 billion available.
Jackie Doyle-Price
I need to make progress. I apologise to my right hon. Friend.
On delayed transfers of care, the Government are clear that no one should stay in a hospital bed for longer than is necessary. Doing so removes people’s dignity and reduces their quality of life. It leads to poorer health and care outcomes, and it is more expensive for the taxpayer. I will set out in more detail the work we are doing to reduce delayed transfers of care. That is critical, because a well-functioning social care system enables the NHS to provide the best possible service.
We are clear that we must make much faster and more significant progress well in advance of winter to help to free up hospital beds for the sickest patients and reduce pressures on overcrowded A&E departments. Last year, there were 2.25 million delayed discharges, up 24.5% from the 1.81 million in the previous year. Just over a third of those delays were attributable to social care. The proportion of delays attributable to social care increased over the last year by four percentage points to 37% in August 2017.
We have put in place an agile and supportive improvement infrastructure, and I have been very clear about priorities. First, in this year’s mandate to NHS England we set out a clear expectation that delayed transfers of care should equate to no more than 3.5% of all hospital beds by September. Those in the system have worked extremely hard to agree spending plans and put in place actions to make use of the additional funding, and they deserve real congratulation for their efforts. Since February, there have been significant improvements in the health and care system where local government and the NHS have worked together to tackle the challenge of delayed transfers of care, with a record decrease in month-on-month delayed discharges in April 2017.
Jackie Doyle-Price
I must make progress. Secondly, we put in place a comprehensive sector-led support offer. In early July, NHS England, NHS Improvement, the Local Government Association and the Association of Directors of Adult Social Services published a definitive national offer to support the NHS and local government to reduce delays. This package supports all organisations to make improvements and includes the integration of better care fund planning requirements to clarify how this and other aspects of the better care fund planning process will operate.
Jackie Doyle-Price
I have limited time, and I really must get this improvement on the record.
The package also includes joint NHS England, NHS Improvement, LGA and ADASS guidance on implementing trusted assessors; the introduction of greater transparency through the publication of a dashboard showing how local areas in England are performing against metrics; and plans for local government to deliver an equal share to the NHS of the expectation to free up 2,500 hospital beds. The package sets out clear expectations for each local area, reflecting the fact that reducing such delays in transfers of care must be a shared endeavour across the NHS and social care. Those expectations are stretching, but they are vital for people’s welfare, particularly over the winter period.
Thirdly, we have asked the chief executive of the Care Quality Commission to undertake 20 reviews of the most challenged areas to consider how well they are working at the health and social care boundary. Twelve of the reviews are under way and a further eight will be announced in November, based on the performance dashboard and informed by returns from July. Those reviews commenced in the summer, and the majority of them are due to be completed by the end of November. They are identifying issues and driving rapid improvement.
Fourthly, we have provided guidance on best practice, including how to put in place “trusted assessor” arrangements, which can allow more efficient discharge from hospital by avoiding duplicative patient assessments by different organisations. All areas have now submitted their better care fund plans, which include their trajectories for reducing delays.
Finally, in October we asked NHS England to extend the GP and pharmacy influenza vaccination service to include all paid careworkers in the nursing and residential care sector. They will be able to access the service via local GPs and pharmacies free of charge.
I know that the hon. Member for Worsley and Eccles South is concerned about the provisions for those that fail to improve, and I want to tackle head-on the suggestion that there will be fines. We are not talking about fines at all. The money that has been earmarked will continue to be retained by local authorities.
Liz Kendall
Leicestershire County Council fears that it could have £22 million removed from its budget because of fines for delayed discharges, when the Government have cut its funds. The Conservative deputy leader, Byron Rhodes, says:
“I can’t think of anything more stupid.”
The Conservative leader, Nick Rushton, says:
“How long can we put up with the Secretary of State?”
That is the reality of the policy. What is the Minister going to do about it?
Jackie Doyle-Price
I reject the suggestion that there will be any kind of fine. The £22 million that the hon. Lady talks about will be retained for spending within Leicestershire. That funding has been allocated for a specific purpose, and where local authorities are not showing the improvement that we expect, we will work collaboratively with them and advise them how best to use that money.
Let me put on record exactly what we are going to do. There is significant variation in performance across local areas. We know that 41 health and wellbeing boards are collectively responsible for 56.4% of adult social care delayed transfers of care. That cannot be right, when other local authority areas have none. In particular, Newcastle has no adult social care delayed transfers of care, and if it can do that, other areas can as well, provided we have good partnerships and good leadership. I trust that I have demonstrated the extent to which the Government are supportive of the best performing systems where local government and the NHS are working together to tackle this challenge. However, we are clear that we must make much faster and more significant progress in advance of winter to help to free up hospital beds for the sickest patients and to reduce pressures on our A&E departments.
It is right that there should be consequences for those who fail to improve. Earlier this month, we wrote to all local authority areas informing them that if their performance did not improve, the Government may direct the spending of the poorest performers—it is not a fine—and we reserve the right to review allocations. It is important to note that the allocations will remain with local government to be spent on adult social care. It is not a fine; this is about making sure that public money delivers the intended outcomes.
Barbara Keeley
Is the Minister saying that revising an allocation is not a fine? When an allocation is revised—presumably downwards, not upwards—that is a fine.
Jackie Doyle-Price
I am sorry, but that is not the case. The money will be retained by local government, but we will direct the spending to achieve the outcome the money is intended to deliver. That is exactly what we should do as a Government, and it is how we ensure value for money.
The health and care system has committed staff and managers up and down the country who are working every single day to deliver the best outcomes for people.
Jackie Doyle-Price
I have already taken too much time.
The measures I have set out have given our hard-working workforce and their leaders clarity about how the Government expect the NHS and local government to work together to achieve the joint ambition of reducing delayed transfers of care, which will be instrumental in delivering high-quality care.
To summarise, we accept that there are significant challenges in the health and care systems, which is why we are increasing funding in real terms over the lifetime of this Parliament, but this is not just about money. It is about sharing innovation and best practice; it is about integration and defining new models of care; it involves thinking about a long-term sustainable solution to the care system; and, most importantly of all, it is about supporting the 1.5 million people who work in the care system, as well as the millions of people who selflessly look after families and friends with little or no reward. We are committed to all of these.
Several hon. Members rose—
Madam Deputy Speaker (Dame Rosie Winterton)
Order. Before I call the hon. Member for Central Ayrshire (Dr Whitford), who is speaking for the SNP, let me say that we have a lot of speakers this afternoon, so after her speech I will bring in a time limit. The time limit will be five minutes to start with, but it may have to be reduced later.
Dr Philippa Whitford (Central Ayrshire) (SNP)
We have all seen the figures about everyone getting older. If we look over the lifetime of the NHS from 1948 to the predictions for 2030, we see that the number of people over 65 will double and the number of people over 85 will increase by 10 times, yet the number of funded places for care has gone down by a quarter. Those two things simply do not match up. As the Minister mentioned, those under 65 with disabilities or learning disabilities are also, thankfully, living longer. The problem is to provide them with care. As a doctor, I obviously tried to do my little bit for people living longer. We should not look at this as a catastrophe; we must celebrate it. We are all heading there, so it is in our own vested interest to ensure that the services will be there for us.
We know that a lot of people’s state of health in older age is laid down in the early years. In Scotland, we are focusing on the early years collaborative—from the baby box for every newborn child, the 30 hours’ early learning entitlement, doubling active transport and rolling out through schools what is called the daily mile. However, we will not get a financial return on that for 50 or 60 years, so we must also invest in our older citizens. In Scotland, we are trying to expand elective services to meet the demand for operations on hips, knees and eyes, but the King’s Fund reports that hip and knee joint replacements are being rationed, and we know that three quarters of trusts have set such strict limits on accessing cataract surgery that people are, in essence, losing their sight, and certainly losing the ability to drive, with half of the trusts fixing only one eye.
Doing such things means driving people into their own homes and into isolation, as well as increasing their need for care and increasing the speed, or lowering the age, at which they need care. It really does not make sense. Age UK points out that 1.2 million people are not getting the care they need, and that matches almost exactly the 1 million family carers who are actually providing the bulk of the care required. In Scotland, we have already committed to raising carer’s allowance from £60 to match jobseeker’s allowance, but that is pretty paltry for someone working, in essence, seven days a week, while 40% of them are reported not to have had any respite or break in a year.
Such a situation arises because the statutory system is not supporting carers, and we need to look at this. Care homes are closing because of the extra costs brought in by the national living wage, and part of that is simply because the price paid is being driven down. As has been mentioned, over half of local authorities are seeing either home care providers or nursing and care home providers closing. The thing is that we need to pay people a decent wage—not the national living wage, but the real living wage. This needs to become a profession that attracts and retains people. Who would we like to look after us or our mother or father—someone who is doing it only for six months until they can get something better, or someone who actually believes in looking after our older population with the greatest possible love, care and dignity?
We need to put in the funding. The Minister talked about the better care fund, which has indeed put in extra money, but that is at the cost of the new homes bonus in England, while local authorities are also being told to build more houses. What are they meant to do? We need to put this on a sustainable footing. We also need to address the issue of those under 65. In Scotland, our programme for government includes a commitment to the under-65s with what is called Frank’s law, in honour of a football player from Dundee who developed early dementia. We have people aged under 65 with the same needs—those with early dementia, multiple sclerosis or motor neurone disease. Why should their birth date dictate whether or not they get help?
Christine Jardine (Edinburgh West) (LD)
The hon. Lady is painting quite a rosy picture of the social care system in Scotland, but does she not accept that it has serious problems as well? In my constituency, I know of a gentleman who was in hospital 150 nights after he could have been transferred because no care package was in place. Freedom of information inquiries have shown that people have spent 400 nights in care when they could have been transferred. Does she accept that the picture in Scotland is not entirely rosy?
Dr Whitford
I totally accept that the position is not entirely rosy. I said many times in the Chamber before the hon. Lady entered the House that we face the same challenges. Those challenges are increased demand, workforce needs—they will be made significantly worse by Brexit—and the fact that money is tight. We face exactly the same challenges. Some of the patients she refers to will have had particularly complex needs that it was a struggle to meet. We are talking about the fact that we are funding free personal care—it is not based on means-testing—and we are working towards providing it for under-65s.
Everything happening in England at the moment will seemingly be solved by the sustainability and transformation plans, yet they have been set backside forwards, with designers having to work backwards from the budget line, which is made the predominant thing. That will not produce the desired result, and it must be recognised that supporting people at home and in the community is desirable in its own right. None of us wants to be stuck in a hospital or in a care home if we could be looked after in our own home; that is the choice we would all make. That will not necessarily cut the money required by a hospital. The nurses will still be there, the lights will still be on. What it might mean is that that bed can be more effectively used and waiting times for surgery or other treatments can be achieved, and they are not at the moment.
On the news yesterday, there was talk about the inefficiency of operating lists, and the former president of the Royal College of Surgeons clearly said that this comes down to beds. The number of beds in England has been cut in half over recent decades, and the problem is that if a patient cannot be put in a bed before or after the operation, the operation cannot be done. That is often discovered only the day before, and we cannot just drum up another bed.
All sorts of things, not just delayed discharges, are driving inefficiencies within the system. The thing generating the biggest pressure on the NHS has been the cuts in funding to social care that mean that by 2020 in England a funding gap of more than £2 billion will have to be met. We all want to look forward to a dignified older age. We hope that we will be independent and healthy. We need to invest in that, yet public health spending has gone down 5%. Should we need care, we will also want care that is dignified and decent. That has to be funded.
Dr Sarah Wollaston (Totnes) (Con)
It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford) and I particularly commend her comments on the importance of prevention, which we must not forget. I join the Minister in paying tribute to the wider care and health workforce, and of course the many unpaid family carers for all that they do. I would like to touch on the forthcoming consultation and some of the current and future challenges. If hon. Members will forgive me, I will take very few interventions because I know that many are waiting to speak.
On the consultation, the Health Committee yesterday had the pleasure of hearing from members of the House of Lords Committee on the Long-term Sustainability of the NHS on the subject of the long-term sustainability of the NHS and social care. They started out with the remit of talking about the NHS, but rapidly realised that the two systems are completely inseparable and that we have to stop considering health and social care in separate silos. The Minister will hear overwhelmingly from the people who contribute to the consultation that we cannot keep thinking of these systems in isolation, so right from the outset will she make it a consultation on the sustainable future funding of both health and social care?
One thing that we heard loud and clear from members of the Lords Committee yesterday was that we need to do more about future planning and that the system for this has been dismal for decades. Their recommendation was that we should set up an office for health and care sustainability that gives us all good-quality, reliable data about not only the demographic challenges but the future needs of both systems so that we can plan ahead for the costs we face in a realistic manner.
Too often in this House we have very divisive debates on this issue, and the challenges in funding future health and care costs are so enormous that I fear the only way we will meet them is by those on both Front Benches and all Members across the House agreeing that we need to work jointly to reach solutions, because no political party has a monopoly on good ideas. Particularly in a hung Parliament, where it is very difficult for us to pass primary legislation, the only way we will move forward on behalf of the people we all represent—we all want the best for them—is if the solutions are worked towards jointly across the House. I hope all Members will move forward in this debate in a spirit of co-operation, because we have to fund this properly. I am afraid that there is a funding gap, although I absolutely welcome the £2 billion that has been pledged. There is consensus that by the time we reach 2019-20, we will face an estimated funding gap, despite the uplift, of more than £2 billion. That will have a real impact on all those we represent.
We must fund this properly not just now, in the short term, but in the long term, and we must come forward with solutions, but it is not just about funding. It is about staffing, and planning properly for a wider workforce across health and social care, so I very much hope that that will also be included in the consultation. Unless we plan ahead for our future workforce, we will always be playing catch-up, as we do at the moment. Of course, we have seen many important changes. In the future, for example, healthcare assistants will be able to train to move forward through the apprenticeship route to become nursing associates and on into degree nursing. We know from Camilla Cavendish’s review that it is not just about pay in the sector but the lack of continuing professional development and training opportunities and, in particular, the inability to rotate through the NHS and social care community settings. That gives an example of how the Government are making some positive moves, which I welcome.
I hope that from the start the consultation will cover both health and social care and that the Minister will go further in covering not just the sleep-in crisis but some of the many other issues that affect my constituents. For example, some are having their assessments re-examined, and disabled young adults facing a change in the support that will be available to them. I hope that the Minister will meet me to discuss some of the issues raised by my constituents in Kingsbridge who face significant changes to their care.
Liz Kendall (Leicester West) (Lab)
It is a privilege to follow the Chair of the Health Committee, and I shall pick up on some of the themes she raised.
During the election, Conservative Members were no doubt dismayed that their manifesto proposals were dubbed a “dementia tax”, conveniently forgetting their “death tax” assault on Labour in 2010. While some of us could be forgiven for experiencing more than a little schadenfreude, the truth is we face a fundamental problem. Our population is ageing, more people need help and support and our care services desperately need more money to cope, yet any party that comes up with a significant proposal for funding social care risks their political opponents destroying them.
We could carry on like this for yet another Parliament, and yet another election, or we could face up to reality: we will only get lasting change if we secure a cross-party approach. That is why I have joined the hon. Member for Totnes (Dr Wollaston), the right hon. Member for North Norfolk (Norman Lamb) and other Select Committee Chairs in calling on the Prime Minister to establish a cross-party commission on the future funding of health and social care. We cannot allow this issue to be kicked into the long grass any longer. More than a million people are not getting the help and care they need. Many end up in hospital, and are getting stuck in hospital for longer. That is not good for them, and it costs the taxpayer far more.
It is not just the people who need care who face a daily struggle. Six and a half million people in this country now care for an older or disabled relative; 40% of them have not had a break for a year, and a quarter have not had a single day away from caring in five years. What is the result? A third of unpaid carers have to give up work or reduce their hours, so their incomes are reduced, the cost of benefits increases and the economy is denied their talents and skills. The failure to deal with the funding problem has not just created a care crisis—it has created a crisis for families and our economy.
Alongside a significant and immediate injection of cash, which we must see in next month’s Budget, three long-term questions must now be addressed. First, what is the right balance between the contribution made by individuals and the state? Do we leave all the extra costs of care to individuals who are unlucky enough to need it, and who might end up seeing all their savings wiped out as a result, or do we pool our resources, share the costs and risks and create a fairer system for all?
Secondly, what is the right balance of funding across the generations? The Conservative manifesto proposals were deeply flawed, but with the longest period of wage stagnation for 150 years and rising personal debt, I do not believe the working-age population can pay for all the additional costs of caring for our ageing population. Wealthier older people will need to make a contribution, too.
Thirdly, how do we get rid of the inequities between the NHS and social care, and make the fundamental reforms we need to provide a single joined-up service and shift the focus of care and support towards prevention? The Barker review for the King’s Fund rightly calls for a single budget for the NHS and social care, and a single body to commission services locally. It also says that we must face up to the deep unfairness that while cancer care is provided free at the point of need on the NHS, if you suffer from dementia, you may have to pay for all your care yourself.
These are inevitably difficult and controversial questions, but the Prime Minister’s experience during the general election campaign and Labour’s experience in 2010 simply reinforces the argument that we need a cross-party approach. The Government must now act.
Maggie Throup (Erewash) (Con)
It is a pleasure to follow my fellow east midlands MP, the hon. Member for Leicester West (Liz Kendall).
Like many Members from across the House, I was compelled to speak in today’s debate because of my personal experience with the social care system, and because of my deep respect for all who work in it and contribute to it. For five years, my father has been in the care of a nursing home in Keighley. At age 94, my dad is still in good spirits, but he has significant care needs as a result of a massive stroke in 2012. It is a testament to the fantastic work of our NHS that we now find ourselves in a position where every care home in the country has residents who 10, 20 or 30 years ago would not have survived serious health issues such as a stroke, a heart attack or cancer. For the Government, however, this success in the NHS can be seen as a double-edged sword, with successive Administrations failing to prepare our social care system adequately for an ageing population living with co-morbidities.
Let me be clear, when I talk about adequate preparation, it is not just about additional funding. As we have heard, the Chancellor has already announced an additional £2 billion of funding for local authorities to fund social care over the next three years and has also introduced a precept. That must be welcomed, as it rightly acknowledges the significant extra pressure that our social care system, and consequently our NHS, is now under.
Opposition Members seem to want to blame the Government, whereas successive Governments, going back to when they were in government, failed to act. They failed to act on the royal commission they set up, and they failed to act on the Wanless report and their own Green Paper. As my hon. Friend the Member for Totnes (Dr Wollaston) indicated, we now have the opportunity to effect radical change to the current system, as the Government embark on their comprehensive consultation on adult social care. Others have alluded to the fact that Britain needs a sustainable programme of social care for the long term. We need to stop thinking short term. To achieve that, I would like to explore the idea of removing the social care remit from local authority responsibility and instead placing it under the wider umbrella of the Department of Health, which would become the Department of Health and Care. This stems from the fact that health and social care have now become intrinsically linked, but are currently administered in vastly different ways. If the two are unified, it would allow for closer integration of services and a greater understanding of what demand there will be for future needs from both the social care and health perspective.
It would also protect the social care system from political manipulation, which has happened in Derbyshire at county council level, where the new Conservative administration found itself facing a social care bombshell left by Labour. Over the previous four years, and despite holding around £233 million of Derbyshire taxpayers’ money in its reserves, Labour failed to maintain care homes such as Hazelwood in Cotmanhay in my constituency, in order to trot out the same old line about Tory Government cuts. As a result of this shameful political practice, the county council must now consider closing the care home altogether, because of the significant repairs required to make it safe and warm for residents. I urge the Minister today to do all he can, from the local government point of view, to help Derbyshire County Council to keep this much-loved care home open. There is no doubt that Derbyshire County Council and others face more tough decisions over the next five years. As the MP, I will continue to do everything in my power to ensure that Erewash residents remain well provided for, for both their health and social care needs.
Jo Platt (Leigh) (Lab/Co-op)
Thank you, Madam Deputy Speaker, for allowing me to speak in this important debate.
As I am Member of Parliament for the borough with the largest ageing population in Greater Manchester, social care provision is an extremely serious matter for my constituents. Consequently, social care funding accounts for almost a third of the total spend by Wigan Council. However, hit by local authority budget cuts, there will be an overall reduction in social care funding of £26 million over the next three years. When factoring in the increased demand on social care, the local authority’s black hole rises to £40 million. These funding cuts have been met by the local authority largely through efficiency and transformational programmes to reduce costs while maintaining and, in some cases, improving standards. However, the Government’s proposed supported housing cap, the universal credit roll-out and the living wage obligation all limit severely the services that local authorities can provide.
What we have seen from this Government is an attack from all angles on local authorities, leaving them simply unable to meet their care obligations. The future for local authority funding looks even bleaker. The Government have so far failed to set out a long-term social care strategy, or explain how they intend to fund local authority provision after 2020. This leaves constituents deeply concerned about the care they will receive, and local authorities unable to find any further savings to protect their core service provision. As the ageing population begins to require care services just as budgets are so ruthlessly slashed, the opportunity to realise further reductions in costs diminishes.
Local authorities are rightly very concerned that even the threat of restricted care funding will deter third sector organisations from investing in services. When factoring in the Government’s flawed introduction of their living wage, it is unsurprising that in my constituency planned projects have been cancelled and care provision reduced, resulting in dangerous levels of excess demand in the local care sector. Where does that leave people and who can they turn to? It will force them either to rely on their remaining savings and their family to meet their care needs, or to put the burden on the NHS, with patients who require social care provision sitting in hospital wards instead. Not only are patients not receiving the correct care they require, but this is an enormous drain on already stretched NHS resources.
That brings me to my final point on this vicious circle: the delayed transfer of care. Is it any wonder, when local authorities face budget cuts, that third sector organisations are pulling out of the care sector, the demand for care services is greater than ever, and delayed transfer of care is rising at a rate of 25% per year, costing the NHS £173 million in the last year alone? The social care crisis will continue to grow until the Government propose a fair, comprehensive and long-term funding strategy. This strategy cannot include cuts to local authority budgets or any additional pressures on the NHS, and, most importantly, it cannot risk draining social care patients of their life savings, as the Prime Minister proposed during the general election campaign. I hope that after this debate the Government will realise the extent of the pressure their policies are putting on local authorities, care providers and the NHS, and introduce a national and fully integrated care service that puts social care patients first, and fairly funds the care sector for the future.
James Morris (Halesowen and Rowley Regis) (Con)
It is a pleasure to follow the hon. Member for Leigh (Jo Platt).
I think that there is a consensus in the House that social care is one of the biggest policy challenges we face and that we need to get it right not just for current elderly people, but, as pointed out by hon. Members on both sides of the House, for working-age adults with disabilities. In that respect, it is important to see social care in relation to the mental health of people with learning disabilities. Funding is clearly crucial in this discussion, too, as the Government recognised in this year’s Budget, which increased funding for social care and gave local authorities freedom over the council tax precept. I have seen in the Borough of Dudley, part of which I represent, how that has had a positive impact on the frontline of adult social care.
I want to make two points about the future strategy for adult social care. The first is about structures, and the second about people. Despite positive efforts made—let us not forget it was this Government and the previous coalition Government who introduced the better care fund to begin the process of health and social care integration—the picture is still a fragmented one. People have talked about delayed transfers of care. In reality, there is huge variation across the country in relation to delayed transfers of care, as a result, broadly, of the fact that the process of integration between health and social care has only just begun. We need to move further and faster. I agree with the Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston), that we need to see this system as one system—a health and social care system. We will make progress only if we see it in that light.
It is also important to think about the devolved nature of adult social care. In Greater Manchester, funding for social care and health is devolved. It is probably too early to say whether this has been a success, but there are strong arguments to say that if we are properly to reform the system of health and social care, we should not be trying to do it nationally, as the Opposition are arguing; we should chunk it into smaller bits at a regional level and perhaps give responsibility for adult social care to bodies such as the West Midlands Combined Authority and devolved Mayors. We need a fully integrated system of sufficient scale, however, and I think the regions are the best place to locate that.
The second point I want to make is about people. Others have mentioned the crucial role of people working in the care sector and of informal carers. People are clearly a massive constraint on adult social care, so we need to think carefully about how we develop the carers workforce as we move forward. Others have said that it needs high levels of professional recognition and better career structures and incentives. The objective should be to have people working in the care sector who feel on an equal standing to those in nursing and other professions. Currently, we see the health and social care workforces in two separate places, but we should be perceiving them as a single seamless workforce who need to be developed, with the right incentives, to cater for the needs of our health and social care system. We also need to consider the arguments about statutory rights for informal carers, who do not have any rights at the moment, and we need to think about incentives, because clearly informal carers benefit the economy and reduce costs to the Exchequer.
We need to think about the future of an integrated social and healthcare system. It will require extra funding, but funding will be effective only if we achieve that fundamental reform of a seamless health and social care system capable of responding to the needs of people in the health system and social care. We will achieve that only if we take a radically different view of what we mean by a carer workforce, how we treat that workforce and how we treat informal care. If we get that right, we will make a lot of progress.
Thelma Walker (Colne Valley) (Lab)
I begin with these words:
“The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the disabled.”
Those words, spoken by Vice-President of the United States Hubert Humphrey, still ring true today. Social care should be not just a process of government but a moral duty of care for each and every one of us. We should make sure that every person being looked after in social care systems, whether run by a local authority or a private company, can expect the level of care that any of us would expect for our families and ourselves one day.
Whether someone is rich or poor, has a debilitating illness or is elderly, they deserve to be treated with dignity and respect. Money should not be a factor in the level of care that someone receives. The Conservative manifesto proposed a tax on people affected by dementia. Why do the Government consider people affected by dementia any less worthy than those with, let us say, cancer or diabetes, or those who have had a stroke? Let me repeat myself, Mr Speaker: whether someone is rich or poor, has a debilitating illness or is elderly, they deserve to be treated with dignity and respect.
Dementia costs the UK economy about £26 billion a year. That is enough money to pay for every household’s energy bill for a year. It is estimated that 1,330 people in my constituency have dementia and that every three minutes someone in the UK will be diagnosed with the condition. Every one of us in this place has had, or will most likely have, some experience of supporting someone with dementia, whether a family member or friend, or a constituent whose family has contacted us for support or a neighbour.
Let us not ignore the elephant in the room. Local authorities have faced crippling cuts to budgets owing to the Government’s austerity-driven agenda. My local council, Kirklees, is currently spending £101.8 million per year on adult social care, which is 35% of its total budget. Kirklees has had its direct funding from the Government cut already by £129 million, and a further £65 million will be cut in the next few years. In addition, it is predicted that the number of people in Kirklees over the age of 65 will increase by 29% in the next 13 years. With cuts to their budgets and growing demand, our local councils are struggling to make sure the most vulnerable in society are protected and looked after. Government Members can try to blame the social care crisis on local councils, but we all know that their hard-line austerity agenda is the reason.
I return to the first part of my speech. What Vice-President Humphrey said needs to resonate with every single one of us in this House. This is a moral issue. I feel that we also need to recognise the work that unpaid carers do. In Kirklees, there are 45,400 unpaid carers. These family members, friends and neighbours are often a lifeline to those with long-term illnesses, and I hope the Government will do more to support them.
Derek Thomas (St Ives) (Con)
I concur with pretty much everything said this afternoon. As an MP who recently fought a marginal seat, I fully felt the pain and discomfort over how we handled the proposals for social care. Since then, however, several constituents have come to me having lost family homes because they needed to pay for a family member in care. As we know, the money people have can dwindle down to £23,000 before the local authority steps in.
Our manifesto plan to protect people with up to £100,000 and to ensure that their properties were sold only after they had passed away has been welcomed by those who have come to see me. People often do not realise—I am surprised that the Labour party has not picked this up—that that policy supports our poorest families rather than those who may have greater assets.
I am a Cornish Member of Parliament. Two weeks ago, the Care Quality Commission put our urgent care hospitals into special measures. The CQC’s report, which also looked at social care and the role of the local authority in Cornwall, states that 82 people in the county are in beds in those urgent care hospitals owing to delayed transfers of care, as against 42 in comparable local authority areas. The report makes it clear that Cornwall Council, which has been run by the Liberal Democrats since 2013, has chosen to give half as much funding to social care as comparable authorities do. That has put enormous pressure on Cornwall’s NHS budget, which is currently funding those gaps in social care support. In April, the Government gave a further £12 million to Cornwall council to address the delayed transfers of care, and a further £12 million is promised for 2018-19 and 2019-20.
Our health system is under enormous pressure, largely owing to delayed transfers of care, but we know that our care and support workers need and deserve proper pay that reflects the work that they do and is similar to that of NHS assistants. They deserve that extra money, and they deserve the training that would help them to do their job more easily and safely. My plea to the Government is to do what they can to help Cornwall Council to prioritise social care and help it to address the challenges that it faces in deciding how to allocate funds and how to reward those who provide social care services on the frontline.
It is very easy for people always to blame the Government, and that has been a habit of our local authority—every time a decision is made, it says that it is because of Government cuts—but sometimes the responsibility must be shared by local managers. I welcome the Government’s intention to review social care, but I agree with other Members that their review must look at how we can integrate health and social care, because a weakness in one currently has dramatic impacts on the other.
People in Cornwall and the Scilly Isles deserve the very best care, and there are those on the ground who want to provide it, but all sorts of barriers hinder them from doing so. I ask the Government to work urgently to help our local authorities to address that crisis.
Gill Furniss (Sheffield, Brightside and Hillsborough) (Lab)
Nearly every day, my office is introduced to a new case in which a constituent and his or her family are facing the harsh and difficult realities of a social care system in crisis, but this is not a crisis born out of necessity. Unfortunately, it is the cruel consequence of an ideologically driven cost-cutting agenda in action. It is a crisis that has been created at the heart of No 10.
The Tories have presided over an unprecedented attack on social care budgets. Some £4.6 billion has been taken from adult social care budgets since 2010, at a time when demand is growing. Reports by the King’s Fund make it clear that the adult social care system as it stands is
“failing older people, their families and carers”,
and that it will have a funding hole of £2.1 billion by 2019-20 which, if left unresolved, will continue to fuel the crisis. The same pattern is found in my home town, Sheffield, where there is a growing population of over-65s, all with a longer life expectancy than ever before. Sheffield City Council’s budget has been cut to the tune of £352 million since 2010, and further cuts are on their way.
As a result of the cuts, councils have had to make difficult decisions. Across England, 400,000 fewer people are able to access publicly funded social care, and one in eight older people is living with unmet care needs. The impact on people and their families in our communities has been harrowing. What is more, the deep cuts inflicted by No. 10 are not only cruel, but nonsensical and ineffective. For example, councils are having to limit the hourly care fees paid to providers.
A recent case in my constituency has highlighted the doubly negative effect of limited administration and care payment resources. My constituent has significant daily care needs, and she and the council have struggled to keep up with resourcing those complex needs. Care providers have withdrawn at short notice, leaving the council and the patient’s family frantically trying to find a new provider. The under-resourcing of social care creates the dual problem of a higher than acceptable turnover of providers, and councils without the resources to step in effectively. That causes much upset and pain to the most vulnerable in our society.
Another consequence of the deep cuts is the level of the duty of care that is being placed on unpaid carers, and, as we know, women are largely bearing the brunt of that work. In one case, a granddaughter cared for her grandmother for 100 hours per week, and when she applied for a care package in the hope of receiving some financial support, it took six months to come through. The long-winded process often leaves carers with no support at all. That is not an isolated case; in fact, there are 6.5 million unpaid carers in the UK.
I am proud that in Labour’s election manifesto we pledged to increase carer’s allowance for unpaid full-time carers to align the benefit with jobseeker’s allowance rates. That is a practical and sensible solution, which also seeks to highlight the valuable work that nurses, social care workers and carers do for our communities. Too often, they are sidelined and their efforts shunned. They need a Government for the many, not just the privileged few, to stand up for them.
Crucially, the knock-on effects of a social care crisis are felt acutely by the NHS. Indeed, this year’s general election was the ultimate litmus test for the social care policies presented by the Tories and the Labour party. Labour not only pledged to invest £8 billion to alleviate some of the immediate problems facing social care, but promised to build a new national care service bringing together health and social care, which we would implement following a cross-party consensus. In a civilised society, it is vital for us to pool the risk, and not allow the most vulnerable to fend for themselves in old age.
Meanwhile, the Prime Minister launched a nasty campaign against older people the likes of which we have not seen in decades. Following their U-turn on the dementia tax, the Tories have now turned their attention to blaming and threatening councils with fines and sanctions—
Andrew Selous (South West Bedfordshire) (Con)
As part of my self-imposed induction into membership of the Health Committee, I undertook a tour of various institutions in my constituency in order to understand health and social care better, and learnt about the new concept of independent living schemes. Earlier this year the Queen and the Duke of Edinburgh opened Priory View, which operates an independent living scheme in Dunstable. It presents a model of the way forward for social care. Older people are not isolated or lonely: there are exercise classes and loads of other activities. We need to get accommodation for such people right for the future, as Central Bedfordshire council has done.
I also visited Orchard Lodge care home in Tilsworth, and was struck by the very high standard of care. It has been rated “good” by the Care Quality Commission, and I was incredibly impressed by the dedication of all its staff. Another home, Rosewood Court in Dunstable, a beautiful building with wonderful facilities, closed this year because the owners could not find managers and staff to run it. That obviously caused a huge amount of stress and upset to residents and to their families, who had to move them at very short notice.
I also met some care providers in my constituency. I remember most clearly a conversation with a lady who ran one of the providers. She ran it very well, and is a former nurse who is working in care for all the right reasons. She said, “I would be too ashamed to go into a school to try to attract young people to come into my profession.” That is not right; we must not have such a situation. I asked, “What would it take for you to attract them?” She said, “A salary would be nice.” I asked, “How much?” She said, “£16,000 to £18,000 a year.” That is not much to ask for people looking after us in our old age.
On travel costs, I have said before and will say again that it should shame every one of us in this House that MPs get 45p a mile when we travel on parliamentary business, yet carers are often lucky to get 30p. What is good enough for an MP is good enough for a careworker. We need to sort that out.
Constituents have also raised the issue of the private subsidy of local authority places. It is not right that some people pay much more for the same place in order to subsidise local authorities. Constituents also tell me that they want even more rigour in the quality of care provided, so that we have real respect for those cared for and also real respect and proper career progression for carers.
We must also break down the division between nursing and social care. Simon Stevens has in the past described these as two great tribes of the healthcare system. There could, in a properly regulated way, often be more co-operation; they could do more together, which would be more efficient.
I have called for a number of steps that will cost money, and we need real honesty in this debate, because it will cost. I am very impressed by what I have read in both the Communities and Local Government Committee report on adult social care published in March this year and the House of Lords Select Committee report on the long-term sustainability of the NHS and adult social care. Both Committees of this Parliament have in reports published this year pointed us to what is happening in Germany and Japan. Those countries have mandatory social insurance mechanisms, which have been in place for a long time; the German system was put in place in 1994. It is not only Germany and Japan who have got their acts together on funding; so, too, have France and the Netherlands. This is not a recent problem; it did not arise in 2010 or 2015. It has been with us for a long time, and parties on both sides of the House have failed to grasp the nettle.
So I say to the two Ministers on the Front Bench, for whom I have the greatest respect—my hon. Friends the Members for Thurrock (Jackie Doyle-Price) and for Nuneaton (Mr Jones)—that there must be urgency on this issue, and there is a willingness among our constituents for it to be grasped in a fair way. People are prepared to pay more; we know that there is public support for hypothecated taxes—people know that what they pay is going to look after them later in life.
Some of the social insurance systems—those in Germany and Japan in particular— can point the way forward. So I say to the Ministers, “Get on an aeroplane now, go to Japan, go to Germany, and do the preparatory work, so that when we have the Green Paper in January, we can have some really good ideas, and we can grasp the nettle, take this forward and give people the care they deserve.”
Mohammad Yasin (Bedford) (Lab)
It is an honour to follow my constituency neighbour, the hon. Member for South West Bedfordshire (Andrew Selous).
Before my election in June I was the portfolio holder for adult services on Bedford Borough Council. I saw the strain that my team of officers was placed under every day, in trying to meet rapidly growing demand with rapidly diminishing resources. The “solution” to this crisis that the Government put forward during the election campaign was astonishing. The dementia tax is not a good idea that was unpopular; it is a terrible idea that did nothing to address the immediate problem of severe underfunding.
Despite already making cuts of £90 million since 2010, Bedford Borough Council needs to identify further cuts of £27.5 million by 2020. In 2015 the grant received from central Government was £30.1 million; that will fall to £5.8 million by 2019-20, and is falling by £6.8 million next year alone. The social care precept is not a proper solution at all, and it is not nearly enough to bridge the gap. It is an inadequate sticking plaster for an ongoing funding shortfall, and a token gesture that pushes the responsibility away from where it really lies, which is with central Government.
A report published last year by the Nuffield Trust and the King’s Fund on cuts to social care for over-65s found that access to care depends increasingly on what people can afford and where they live, rather than on what they need. The report found that underinvestment in primary and community NHS services is undermining the policy objective of keeping people independent and out of residential care. It also found that the Care Act 2014 has created new demands and expectations, with no extra funding to meet them.
The report also said that local authorities have little room to make further savings, and most will soon be unable to meet basic statutory duties. Bedford Borough Council is close to not being able to meet those duties. Fining local authorities for delayed transfers of care will do nothing to help address the problem, and will worsen the funding crisis. The Government’s response to the social care crisis that we know exists in every local authority area up and down the country is hopelessly inadequate to deal with the levels of demand.
The Government have no answers to the social care crisis they have created. The only change needed now is a change of Government.
Mr Marcus Fysh (Yeovil) (Con)
Our ageing population is undoubtedly one of the challenges of our age, and I am proud of what we are doing locally in Somerset to be in the vanguard in this country on the integration of health and social care, which is an essential part of meeting the challenge. Some of our care providers have faced incredibly big challenges over recent years. The rise in the national living wage has put a lot of pressure on their budgets, as have rising pension costs and rising regulatory fees, the apprenticeship levy, and the normal inflation in rent and other costs. It is my understanding that our current council fee rates for care cover only 70% of the costs.
We also need to focus very carefully on the issue of sleep-in shifts and the national living wage being applied to that. I do not think it is sustainable for us to allow that, and we should try to legislate against it. Care providers in my area have informed me that it is not the same as waking duty hours.
Somerset Care is a well-run not-for-profit company that is performing very well and is a key part of the provision of care in Somerset. It is having to hand back some of its contracts from the local authority because they are underfunded, and we have seen 445 fewer beds in the south-west year on year in 2017.
Local authority funding is a factor. It has been drastically reduced, and I am keen to ensure that Somerset is, if at all possible, a pilot in the retention of business rates. I am a firm believer in giving local areas the revenue opportunities they need to be able to innovate and attract more business in various ways, to be able to fund some of these undoubted needs in future.
The sector must provide newer facilities. Some 85% of care home stock in the UK is now more than 50 years old. We need capital funding solutions to be able to lever in private capital. On current parameters, new care homes need at least 70% of self-funders to have the required return on investment. We also need a bigger workforce, and Members have talked about some of the issues in that regard. We need 53% more people in this sector by 2030.
In terms of solutions, several people have spoken about social insurance, and I think that that is probably the best way to try to pool risk. However, I do not think this is a risk that should be pooled across the whole of society; that would not be fair. We should also incentivise savings schemes better and give tax breaks, and perhaps VAT exemptions, to the providers of new-build care homes. I have mentioned integration before, and we have seen the vanguard in Yeovil: getting patients out of acute beds and into social care settings earlier can save up to £300 a day, which is very encouraging.
I have already mentioned sleep-in shifts and local dynamism, and I am mindful of the fact that others want to speak, but I want to conclude by saying that I welcome the Government’s paying attention to this issue. It is undoubtedly one we need to look at. This is a pressing matter, and I urge the Government to really motor along on this one. This is urgent for some of those providers who are facing serious situations. I do not believe that the answer is higher taxes, either at national or local level, and I do not believe in politicising the issue, as some Opposition Members have been tempted to do. Essentially, we need innovation. We need to create the conditions for the private sector to work with providers to give our older generations the support that they need.
Tracy Brabin (Batley and Spen) (Lab/Co-op)
I am grateful for the opportunity to speak in this most important debate. I would like to thank my friends on the Opposition Front Benches for bringing the subject of social care to the House today. Social care must be treated as the national priority it rightfully is. It is a vital public service that allows people in every one of our constituencies to live their lives in the way they want. The system supports older people, those living with mental health issues and people with physical and learning disabilities. This should be the least that we owe people in our country, but instead there is simply not enough money in the system. The Local Government Association has said that social care services nationally are facing an annual £2.3 billion funding gap by 2020.
Of course, some areas are affected more than others, and funding pressure is being felt keenly in my constituency of Batley and Spen and in our local authority of Kirklees. As my hon. Friend the Member for Colne Valley (Thelma Walker) has said, a third of the entire local authority budget is spent on adult social care. This is a local authority that has had to effectively cut half its budget since 2010 and is the second worst funded metropolitan council in the country. Senior councillors have openly warned that they might need to stop cutting the grass or collecting the bins in order to meet their social care requirements laid out in the Care Act 2014. Of course it is completely right that social care takes priority over other public services, but I am sure Members will agree that councils should be in a position to provide more and better services to local people, rather than constantly cutting back.
Let us take the case of the father of a constituent of mine. He is currently in Dewsbury District Hospital, and he is ready to be discharged. He has had a stroke, and he also suffers from vascular dementia and a condition called sundowning, which means that his dementia symptoms become more severe in the evening. Because of a lack of funding, there is no specialist provision locally that can cope with his complex needs. This family are faced with the prospect of their relative having to go out of the area, even as far away as Sheffield, for care. We have to find a national solution to this national issue.
The Care Quality Commission’s report earlier this month laid out the reasons for action in black and white. Only 2% of social care services were rated as outstanding, with 41% requiring improvement. A quarter of services are failing on safety and there are nearly 4,000 fewer nursing home beds now than there were in March 2015. This is at a time when demand is rising. In England, 1.2 million people do not receive the social care they need, which is up 48% since 2010.
The search for the much needed solution has to begin with getting the funding right, because the system’s future depends on it. Clearly, one way of not getting the funding right was illustrated by what the governing party put forward at the general election. Its intention to implement a “dementia tax” without limits went down like a lead balloon in my constituency and plenty of others. We have to assume that that policy is off the table—I am sure that Ministers will be eager to confirm that today—but that does not mean that the Government can keep treading water. Social care is a vital public service, and having a hole of this magnitude at the heart of Government policy is irresponsible. We need action. Instead of writing to councils to threaten fines and the withdrawal of funding because of unmet targets on delayed transfers of care, let us have a plan to remedy the £6.3 billion-worth of cuts since 2010. The quality of care needs to be rising instead of falling. Social care is there for the elderly and the vulnerable, and the least we should expect is a decent system that works for everyone.
Several hon. Members rose—
Madam Deputy Speaker (Dame Rosie Winterton)
Order. I am afraid that I am going to have to cut the time limit on Back-Bench speeches to three minutes as a lot of speakers are still waiting to get in.
Helen Whately (Faversham and Mid Kent) (Con)
I am sure that all of us who have been out and about with care workers in our constituencies have found the experience not only informative but inspiring. I certainly had a brilliant experience when I went out and about with a care worker in my patch. I saw the enormous compassion in the care that she provided and how incredibly hard she worked. It was a tough job, but a rewarding one. As many Members have said, however, the work is not well enough paid, there is no career structure and there is not enough support for carers in their day-to-day work.
Everyone in the Chamber today recognises that the current system is not fair and not working. It is not fair that people can get care for free if they can stay living in their home, but if they have to go into a care home, they might be left with only £14,000 of savings. Most people would much rather be cared for at home, but that is not always possible. The present system therefore discriminates against those who cannot stay at home to be cared for, and that is simply not fair. We need to bear that in mind as we talk about potential solutions. Let us not pretend for a moment that the current system is fair.
The system is also not working. Around 30% of the people in hospital in my constituency do not need to be there. They would be better off out of hospital, but there is often no outside support available for them. Delayed transfers of care are an ongoing challenge. There are also people in care homes because of the shortage of domiciliary care. We have to address what is substantially a funding challenge: there is simply not enough money going into care.
The shadow Minister, the hon. Member for Worsley and Eccles South (Barbara Keeley), said that she was going to give us Labour’s solutions to the problem. I listened carefully to her speech, but I was disappointed that she spent only about one minute of her 24-minute speech talking about potential solutions. I am afraid that I did not really hear any solutions—
Helen Whately
I am really sorry, but I cannot take any interventions. I have been asked not to.
Most significantly, the hon. Lady does not have a plan for how to pay for all this. It all comes down to how we are going to pay for improving access to care, and the Labour party simply does not have a plan. As for cross-party working, that would be fantastic but judging by some of the language I have heard from Labour Members, I do not think that many of them are ready to work together on this. I encourage the Government to get on with the job of proposing a better, sustainably funded, care system so that our constituents can get the care that they need.
Faisal Rashid (Warrington South) (Lab)
Under the Conservative Government, social care is in crisis. That is clear to almost everyone in this House, and to the 1.2 million people across the country whose complex needs are not being met. In fact, it would appear that the only people it is not clear to are those in the Conservative Government. Anyone following either of the Secretaries of State responsible for social care over the conference period would have struggled to find any reference to the crisis, or indeed to social care. I am therefore pleased that the Opposition have used this day to bring this incredibly important issue to the Floor of the House, because we are faced with a complete Government policy vacuum.
Social care provisions have been neglected and gutted by central Government. By March 2018, £6.3 billion will have been cut from the adult social care budget during eight years of Conservative-led Government. Over the same period, the number of people with some form of unmet need will have increased by 48%. That is no coincidence. The Conservative Government’s failure to tackle the social care crisis is having a hugely damaging impact on elderly and disabled people in our society, pushing them into increasingly vulnerable and precarious positions where they are not receiving adequate or appropriate care.
Government cuts to local authority budgets mean that councils are simply no longer able to provide the necessary level of care. In the first five months of the fiscal year, 48% of authorities have reported home care providers handing back contracts, and Warrington Borough Council is no exception. Indeed, two providers have already handed back significant contracts this year, so the council is short of approximately 500 hours of home care on any given day, resulting in delayed transfers of care. Members will be aware that the Government’s response to the delays has been to punish local authorities fiscally for not meeting unrealistic targets by withholding funding and threatening extortionate fines. If the Government are not prepared to invest in essential care for the health and wellbeing of the elderly and disabled in society, what are they prepared to invest in? During the 2017 general election campaign, the Prime Minister infamously U-turned on her flagship social care policy. Five months later, she has still to provide us with any alternative, while other members of her Cabinet have yet to rule out the discredited dementia tax policy.
Kelly Tolhurst (Rochester and Strood) (Con)
Thank you, Madam Deputy Speaker, for calling me to speak in this debate on a subject that is vital to many in our communities and one that is close to my heart. It should almost go without saying that those working in social care deserve huge respect and thanks for their outstanding work on a daily basis. My role as chair of the all-party parliamentary group on social work presents a real opportunity to champion the sector and to work with colleagues to get the best deal for it.
No one doubts the importance of funding for important public care sectors, but the Opposition do not seem to realise that money alone does not solve everything. Addressing working conditions is hugely important for maintaining continuity and retaining workers. We should be looking at cutting the bureaucracy that increases the organisational work in these caring roles and at allowing them to do more of what they want and are trained to do. We should also consider how technology can help people in the sector. Medway Council has been looking at that in relation to caring for people in their homes, and some of our housing associations have worked with the council. These are ideas, and I am pleased to speak to colleagues from across the House instead of just throwing money at the problem, creating a financial black hole, and hoping that something comes out in the end.
If Opposition Members want to talk about money, they will surely recognise the additional £1 billion made available this year on top of the £2 billion offered to councils in the Budget. Since 2015, councils have had access to a total of over £9 billion of funding over a three-year period. We have also introduced the toughest standards regime in the world, and it is reassuring that the CQC rated 80% of social care settings as good or outstanding. Again, this is about ideas, not just funding, which is why an open consultation will be held on how to reform the system to drive sustainability and improve quality. In my area, Medway Maritime Hospital was struggling, but it is clear that change has been down to leadership, management and innovation in that setting.
In comparison, Labour’s record does not give Opposition Members a high horse from which to look down on us. In government, they failed to deliver effective policies over a long time. Their advisers even came out in public to admit that they failed to solve the problems of social care funding, saying that it was
“the largest piece of unfinished social reform”
during Labour’s time in government, which I remind the House was 13 years. Even during the most recent election, promises were made, but we heard no plans from the shadow Minister for what Labour would do, so I support my Government in holding the consultation and wish them good luck.
James Frith (Bury North) (Lab)
It is a pleasure to speak in this Opposition day debate, and I thank colleagues for bringing it to the House. I pay tribute to the work of Carers UK and the Bury Carers Centre in my constituency in advocating and providing a voice for Britain’s 6.8 million carers, almost 20,000 of whom work in Bury. In fact, it is a mark of the link between my office and the Bury Carers Centre that Ummrana Farooq came to help me with my constituency work and run my office—such is our commitment to the Bury Carers Centre.
The number of carers has grown by 1 million nationally over the past 15 years. Carers now provide care worth £132 billion every year, which is propping up a social care system in crisis. If we acknowledge the silent wards in bedrooms and front rooms and the people being looked after by loved ones, the crisis would be deeper still. Under the Tories, 400,000 fewer older people now have access to publicly funded social care and not because need has reduced; it has of course risen. Age UK says that 1.2 million older people in England now have unmet care needs. The Government’s welfare policies have had an extremely detrimental impact on carers. Some 2 million people have given up work to care for relatives. The low level of the carer’s allowance—£62 a week if caring for someone for more than 35 hours a week—and the freeze on many benefits combine into a toxic force against our carers and their communities.
I want to progress the debate. As a Greater Manchester MP—it is good to hear so many Greater Manchester MPs speak in this debate—I understand that there is a role for hospice care in the social care offer. We need a holistic approach, and we need practical arrangements, not just new money. We need three-year budgets up front. Hospices can play a vital role if the patient tariff can move from the ward to the hospice. They can offer vital respite care provision in towns such as Bury. Bury hospice has empty beds and rooms that would cost a lot less than a hospital bed for the night, so I urge the Government to look at the patient tariff. Have they considered the supporting role that hospices might play in the social care system? Come and look at Bury hospice and the work we intend to do with our Pennine colleagues.
Huw Merriman (Bexhill and Battle) (Con)
East Sussex has the second-highest proportion of over 85-year-olds in the country, and that number is expected to grow by 14% by 2021. As for the care homes in my constituency, 55 of them are rated good, but unfortunately 29 require improvement and one is inadequate. Not only does East Sussex have a large population of people who need to be looked after, but the system is clearly not working as it should. In my constituency, 33% of the working-age population are on the living wage, so to continue to expect council tax payers to fund the social care model will not help them get on in life and will not help intergenerational fairness. I was therefore pleased to hear the Prime Minister talk at the Dispatch Box about the short-term impact of the Government’s £2 billion announced in the previous Budget and the council tax levy. However, due to the situation with council tax payers and the small tax base that I have in East Sussex, I support her when she talks about the need for medium and long-term reform.
In the medium term, East Sussex’s model is to work as a Better Together partnership, where the council, the NHS trust and clinical commissioning groups all work as one. Indeed, they are all on one email and have emailed me over the past couple of days about what can be done, which shows that they really are working together.
As I have mentioned, our accident and emergency team is the most improved in the last six months because the Better Together partnership is now working. People are now getting out of hospital earlier and, indeed, are not having the trips, slips and falls that cause them to go to A&E. The model works well.
However, I have one ask of the Minister, who has a background in compliance. The NHS trust is managed by NHS Improvement and the clinical commissioning group is managed by NHS England, and the regulators are not working together. Those organisations therefore sometimes struggle to work together, such as on billing, contractual challenge and payments, because the regulators are telling them different things. I would like a single accountable regulator for the entire sphere, and I hope that my leaders will be able to meet the Minister to discuss their challenges and what can be done.
Cross-party consensus is surely the way forward. I hope the Opposition will note that I have not once attacked them. I have heard some fantastic speeches. In particular, the hon. Member for Leicester West (Liz Kendall) talked passionately about what we can do together. In reality, we will have no majority for these five years, and social care will be reformed only if we work together. Please, can we do so?
Laura Smith (Crewe and Nantwich) (Lab)
Social care has been pushed into a state of emergency. A report by the CQC in July found that one in four social care services is now failing on safety grounds, with at least one care home closing every week. Only 2% of providers are regarded as outstanding.
In Cheshire East, almost a third of care homes have been rated inadequate or as requiring improvement. Imagine the uproar if Ofsted published such statistics for schools. The CQC’s chief inspector, Andrea Sutcliffe, admits that adult social care is still approaching a “tipping point.”
The only reason the social care service has not completely fallen to pieces is because it is being held together by an incredible and skilled workforce who are swimming tirelessly against the tide. A recent Unison survey of homecare workers found that more than three in five are given only 15 minutes, or less, to provide personal care. Three quarters end up rushing and have to compromise the dignity or wellbeing of those they look after. Nearly a third are unable to wash, bathe or shower the people for whom they care.
I am always lost for words when I speak to care workers in my constituency. It takes a certain kind of person to be a care worker, and imagine how it must feel for that type of person to be forced to leave somebody for whom they care before they have had time to wash them or to help them eat. To make matters worse, many work on poverty pay, a consequence of the chronic underfunding of this service.
The National Audit Office has stated that 220,000 care workers in England are being paid below the minimum wage—the national minimum wage, not the Government’s living wage. Care workers in my constituency have been underpaid for years by Cheshire East Council, which is breaching minimum wage regulations despite having a policy to pay all workers at least the local living wage. Those workers have yet to receive back pay for the duration that they have been underpaid, and it is unclear whether that back pay will lift them to a living wage.
Only yesterday, a care worker contacted my office because he did not know where else to turn. He described how staff morale is at rock bottom, with many care workers suffering from poor mental health, worrying about their job security and relying on food banks and payday loans. They are too scared to take time off sick and unable to afford annual leave. He described how care workers feel that they have no voice and receive no respect. Is it any wonder that more than 900 care workers are leaving their job every single day?
Vicky Ford (Chelmsford) (Con)
Thank you, Madam Deputy Speaker, for giving me the opportunity to speak on the extremely important subject of how we care for the elderly and the most vulnerable people in our society. I start by declaring an interest. I come from an NHS family, and the NHS is in my blood. My husband is a consultant oncologist, and the work that he and others do in the NHS is saving lives and ensuring that we are all living longer. I thank our NHS.
It is because we are all living longer that we feel this pressure on our NHS and social services. I am an Essex MP, and in Essex it is predicted that in the next decade the number of over-65s will increase by 40%, the number of over-85s will increase by 50% and the number of over-95s will more than double. Also, a growing number of people have complex needs, such as diabetes, dementia and other conditions. In the next three years, the number of adults in Essex with physical disabilities will increase by more than 7%.
In England, 80% of our care homes are rated good or outstanding by the CQC, but we need to consider the long-term way in which we fund and care for our growing elderly population. Stuff is being done on the ground. We know that the NHS and social care are linked, and having integrated health and social care discharge teams is working in Essex and is helping to speed up transfers.
Essex plans to have 2,000 supported independent living units, which will help vulnerable people to stay in their own communities for longer. We can do more on caring for the carers. We are introducing nurse apprenticeships, which I hope we will soon see in Chelmsford—that is excellent.
This country is also doing phenomenal work in science and research. Some £4.7 billion is being invested in science and research, more than any Government have invested in the past 40 years. We are leading the world in areas such as genomics and gene editing, which will radically change personalised medicines and will mean that many people will not need to live with certain conditions.
Although those changes will all help in either the short term or the long term, we need to look at funding now, which is why the Government are right to call this consultation. We need to consider what is happening in other counties, such as Germany, Japan and the Nordic countries, and we need to look at savings models, insurance schemes and equity release. We need to work with our local authorities. Let us have this consultation, and let us work together.
Mike Amesbury (Weaver Vale) (Lab)
The benchmark of a civil society is how it treats its elderly, its vulnerable and those who need support the most. Those are the values that underpin the outstanding work that happens every day in my constituency, Weaver Vale, and in constituencies across the country.
Whether care workers, nurses, social workers or volunteers who look after their neighbours, these people are motivated by a simple principle. As a country, we should care for, and care about, everyone in our society. Sadly, the reason we are having this debate today is that, when it comes to sharing and showing support for those values, this Government have let down the very people who deliver them and have failed those who rely on them.
Year after year, as they delivered their cuts, the Government who claimed that we were “all in it together”—remember that one—took aim at the most vulnerable instead of protecting them. Councils in my constituency have seen their budgets cut by 43%, with the most vulnerable struggling to access the care they need. Like many former councillors in this Chamber, I saw at first hand what cuts did to services and the effect on the people who relied on them. Now, as an MP, I witness this all too often. That effect was ignored by this Government again and again, until the Prime Minister was finally forced to listen. Even then, the action offered failed to deliver what was needed, putting the burden once again on local councils and residents, rather than on Downing Street, the only place that can deliver the proper funding needed to rectify this crisis.
The good news is that with proper, decent funding we can make a difference, by providing our amazing social care staff with the support they so desperately need. That is why we need a Labour Government. Earlier this month, I met the integrated care team in Cheshire West and Chester. Based at a local medical centre, they bring together district nurses, care workers, social workers, occupational therapists and co-ordination staff, providing excellent integrated care. The innovation and dedication of the team is exemplary, but unfortunately the funding is not. The workload exceeds staffing resources. The team needs six district nurses, but it typically operates with three or four. Recruitment is a struggle, and there is a shortage of carers in the area. Patients can be ready to leave hospital but no care packages are in place because of the lack of funding. This is the consequence of years of cuts and of pay freezes, zero-hours contracts—
Rachel Maclean (Redditch) (Con)
It is a pleasure to follow the contributions from Members on both sides of the House today in this extremely important debate. I have personal experience of this, as my 80-year-old mother is in the early stages of dementia. She lives in Cumbria, many hundreds of miles from this place, and I have often had to run from these Benches to take phone calls from the local authority services in the past few weeks. I have seen for myself the experience that many of our constituents and their families are going through. I pay tribute to those who are at the sharp end; I have seen some fantastic examples of caring people in Cumbria and in my constituency. So I commend the Prime Minister and the Government for seizing this difficult and challenging issue. She was brave enough to talk about something that has been an issue for many, many years. Opposition Members have been very negative and critical of us. They are right to criticise our election campaign—not everything was right in it, and there are problems now—but I welcome the calls to work together. I really want to see us work together across this House to deal with this issue.
I make one plea to Opposition Members: please do not talk about a dementia tax, as there is no such thing. When I spoke to people in my constituency, I found that they were very concerned about the challenges that face their families and people in their communities, and this language was terrifying to them. It obscured the fact that care is not free now. Currently, people are being forced to sell their homes and they do face difficult challenges. We are right to have this debate, but please let us not do it in a way that frightens people who are vulnerable already.
We do face some big challenges and it is very important that we get the health and social care sector working together. I welcome the fact that in Redditch £100 million is being put into our accident and emergency in the Alex and we have a new elderly and frail unit, which helps to speed up the process of people leaving hospital when they need to go. I wanted to make a number of points, but time is short, so let me say that it is right to look at a balance of solutions.
I welcome what the hon. Member for Leicester West (Liz Kendall) said about people who are wealthy and can contribute. We need to consider how can we have a grown-up, intelligent and mature debate about that, because we are facing a large demand on the public purse to fund this in the next few years. The Labour party put forward a manifesto in 1997 to deal with this issue, but it was not resolved. We have grasped the nettle. I thank our Front-Bench team for bringing this forward. Let us have the consultation and deal with this for our constituents.
Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)
We have heard that the Local Government Association has estimated that adult social care faces a £2.3 billion funding gap by 2020, and the reasons for that are wide-ranging. They include a growing population requesting adult social care support, cuts to local authority budgets in recent years and increases in costs to providers, including the national living wage and costs relating to sleep-in arrangements. In addition, the adult social care provider market is increasingly vulnerable, with 69% of councils reporting to ADASS that they have been affected by providers ceasing trading or handing back contracts. That can have a massive impact on the lives of people relying on this care. These short-term pressures must be addressed with additional funding, alongside allowing local areas to use additional funds in the way that addresses their local health and care issues.
Kevin Hollinrake (Thirsk and Malton) (Con)
It is a pleasure to follow the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill), who made a good point about the sustainability of providers, an issue to which I shall return shortly.
I was pleased to see the Communities and Local Government Committee report on adult social care listed as a document relevant to the motion. I serve on the Committee and contributed to that report. We established what I think we are all aware of: there is a demographic time bomb with respect to social care. The King’s Fund said that there are hundreds of thousands of people in their 80s and 90s and that the number grew by third in the past 10 years and will double in the next 20 years.
The problem is not going to go away and there is no doubt that, as a result, the system is under pressure. This is about not only the overall numbers of people affected but the individual devastation. The shadow Minister, the hon. Member for Worsley and Eccles South (Barbara Keeley), referred to “catastrophic care costs”, which is a fair way to put it. It cannot be right that one person and their family can be affected in such a catastrophic way if they have long-term care needs such as dementia. We need to consider the impact on their family and the financial consequences of those catastrophic costs.
It is not right for either the Government or the individual to have a blank cheque on this issue, so we need to look for a different solution. When most of us see a potentially catastrophic risk, we insure ourselves against it. As part of its adult social care inquiry, the Select Committee visited Berlin to look at the German system. Adult social care in Germany was previously funded by local government, but a social insurance system was introduced in 1994. Every person has to pay into the system, although there is a threshold so that low earners are taken care of and do not have to pay. Everyone else pays around 1.2% of their salary, with their employer also contributing. It is a bit like auto-enrolment, but for social care.
The system in Germany has been successful. It was introduced with cross-party agreement, which is what has been called for today by Government and Opposition Members alike and which I absolutely support. In Germany, if care is needed, the money paid out of insurance policies can be paid to family members, so the social fabric element of social care is catered for, because more families look after their relatives when they are in need—they are not unpaid carers; they are actually paid. The German system helps the provision of the right kind of support from the right people, and I really hope that the Government will consider it as a permanent, sustainable, scalable and simple solution to this problem.
Wendy Morton (Aldridge-Brownhills) (Con)
As the Minister clearly set out at the start of her speech, it is right and proper that we recognise all those who work in the social care sector. In fact, my own mum was a home carer for many years. She would go out early every morning and late of an evening to look after the people she was supporting. It is right that we support and recognise not only those who work in the sector, but those unpaid carers who quietly get on with looking after those they love and care for at home. That work often goes unrecognised.
There are several care homes in my constituency, including Pelsall Hall and the Hawthorns, which are part of the whole range of homes that provide social care and independent living for those who really need it. There are also many charities and organisations that provide invaluable support—in particular, the Alzheimer’s Society, which was recently kind enough to run a dementia friends session in my constituency.
Aldridge-Brownhills has an ageing demographic, with 27% of the population aged between 45 and 64 and 21.6% aged over 65, so it is part of the challenge that we face as a country. Not just in my constituency but right across the country, the ageing population presents us with probably one of the greatest challenges we face, and it is one that we cannot leave alone.
We have heard how successive Governments have kicked this can down the road, and I have heard a lot of charges against this Government from Labour Members. They may well protest, but they, too, kicked the can down the road. Labour promised a social care solution in its 1997 manifesto, yet despite a royal commission, two Green Papers and a pledge to address the issue in the 2007 comprehensive spending review, it left government without having delivered.
Today, we have had many good contributions. The one thing that has come across loud and clear is the need for us all to engage in this consultation and to work together, because it is a challenge that is facing the whole country. I really hope that we can find a system that not only works today, but is ready and fit for the future.
Christine Jardine (Edinburgh West) (LD)
Thank you, Madam Deputy Speaker, for allowing me to speak in this important debate. With the 70th anniversary of the welfare state approaching, it is appropriate to reflect on its promise of care from the cradle to the grave and to say that, in this country at the moment, we are perhaps getting that wrong.
We have heard much about the problems with funding and the delays in transfers. Perhaps the most important thing we can do, apart from raising money by putting a penny in the pound on tax as my party advocates, is to stop treating social care and the NHS as a political football. Perhaps it is time that we establish a cross-party health and social care convention to carry out a comprehensive review of the longer-term sustainability of the health and social care finances and workforce and the practicalities of general integration. Perhaps that way we might see a more efficient social care system that is fit for purpose.
Andrew Gwynne (Denton and Reddish) (Lab)
We have had a good and full debate. I wish to thank the 25 Back-Bench colleagues who have contributed to it, including my hon. Friends the Members for Leicester West (Liz Kendall), for Leigh (Jo Platt), for Colne Valley (Thelma Walker), for Sheffield, Brightside and Hillsborough (Gill Furniss), for Bedford (Mohammad Yasin), for Batley and Spen (Tracy Brabin), for Warrington South (Faisal Rashid), for Bury North (James Frith), for Crewe and Nantwich (Laura Smith), for Weaver Vale (Mike Amesbury) and for Birmingham, Edgbaston (Preet Kaur Gill) and the hon. Members for Totnes (Dr Wollaston), for Erewash (Maggie Throup), for Halesowen and Rowley Regis (James Morris), for St Ives (Derek Thomas), for South West Bedfordshire (Andrew Selous), for Yeovil (Mr Fysh), for Faversham and Mid Kent (Helen Whately), for Rochester and Strood (Kelly Tolhurst), for Bexhill and Battle (Huw Merriman), for Chelmsford (Vicky Ford), for Redditch (Rachel Maclean), for Thirsk and Malton (Kevin Hollinrake), for Aldridge-Brownhills (Wendy Morton) and for Edinburgh West (Christine Jardine).
Clearly, on both sides of the House, there is a shared concern over the Government’s inaction on addressing the growing crisis in social care. It has been illuminating to hear the thinking of the Social Care Minister in her opening speech. I am astounded that a Minister of the Crown thinks that austerity is the mother of invention.
Andrew Gwynne
Let me finish. I will let the hon. Lady in if she wants to apologise.
It is a play on words of the old English proverb that necessity is the mother of invention. Let me tell the Minister that she might be quoting a councillor, but she did not deny that it was her view, too. There is nothing necessary about austerity. It is a political choice, and it is a choice that is driving up inequality and unfairness.
Jackie Doyle-Price
I need to remind the hon. Gentleman that the only money that we can spend is that we collect from taxpayers. I pay tribute to the innovation shown by local authority leaders who deliver better outcomes with less money. That is good value for money and should be celebrated by Opposition Members, too.
Andrew Gwynne
I pay tribute to councillors who are making very difficult decisions under very tightly constrained financial situations. I remind the hon. Lady that, yes, we can only spend money that we have, but it is a question of priority about how we spend it. That is why we set out in the election exactly how we would use the money in a better, smarter, fairer and more equal way.
As Members of Parliament, we have a duty to our constituents to defend the services on which many rely and the services that are there to protect us all should we find ourselves in need of support—care homes for the elderly, child protection and support for parents with disabled children. It is the duty of all Members to protect the principle on which our welfare state was founded. All people deserve a life of dignity. As shadow Secretary of State for Communities and Local Government, I speak to council leaders, to councillors, to council staff and to organisations delivering public services, and they are all telling me the same thing. They are not only unable to cope financially; they have lost confidence in this Government. The country needs fresh ideas and leadership. Instead, it is suffering from the weakest and most divided Government in memory. One thing is clear: this Government are facing a looming crisis of trust in local government. Many within the local government sector, including the Tory chair of the LGA, had hoped that the Prime Minister would use her Tory conference speech to announce new measures to help to alleviate the pressures on adult social care. But I, like many, think they were left wanting for leadership.
Our ageing and growing population means that there is more demand for social care. An increasing number of people will need support with their mental health, a physical disability or learning and social needs. Skills for Care has predicted that we will need an additional 220,000 to 470,000 workers by 2025 due to population growth and ageing, but local government will be unable to meet this demand under current and projected budgets.
We do not have to wait until 2025 to witness a crisis. Across the country right now, our health and social care system is straining at the seams. Last year, councils spent over £366 million more than they had predicted on their social care budgets. That is double the overspend reported in 2015-16, and it is not sustainable. The only response that we receive from this Government is the long-awaited consultation, which a Minister first promised would be published in the new year. Now it is suggested that it might even be delayed until next summer.
When will our communities see action to help the one in eight elderly people who will not receive the care they need, such as help getting dressed, going to the toilet and washing themselves—basic dignity for those most in need? When will we see an end to the closure of children’s centres that are providing support to families in need? Right now, one children’s centre closes every week. When will people no longer have to live in fear in their own homes? Cuts to care hours mean that a fall in the home could leave somebody trapped on the floor, unable to get up for several hours. If Ministers had discussed these issues with the sector, they would know about them. They would know that the sector is warning that social care faces a perfect storm of staffing shortages, rising demand and a lack of funding made worse by this Government’s policy on transfer of care.
I recently asked the Minister whether his Department had conducted an assessment to ensure that local authorities had the financial and staffing capacity to comply with their statutory social care duties. I was told that these were decisions for local authorities, not for the Government. Well, I have done the work for the Minister. The number of social care workers has fallen each quarter for five years to its lowest level since 1999. It has decreased almost 8% in the last year alone. Councils face a £2.3 billion annual social care funding gap by 2020. With this black hole in the Budget, I am unable to understand the justification for fining cash-strapped councils for failing to meet transfer targets. The Minister denied that it is a fine. But if it looks like a duck, waddles like a duck and quacks like a duck, it is a duck; and this is a fine.
The Government are at odds with the whole sector. As the LGA has also argued, I am unable to see how this will not make the financial pressures affecting social care even worse. Ministers have failed to understand the depth of the problem with delayed transfer. Too many patients are stuck in hospital who could be better cared for elsewhere, but ensuring that patients can be cared for in the right settings requires investment in not only social care, but intermediate care, reablement services, and sheltered and supported housing. Added to that, we know that there are issues about pay too.
I urge the House to recognise that this problem does not fall on party lines: these cuts hurt all our communities, whichever side of the House we sit on. The Evening Standard reported this week on a new poll. Three quarters of Conservative councillors said that long-term funding for children’s social care was a major concern. Over half said the Government’s cuts had made it difficult to deliver legally required services. So this is a crisis in not just adult social care but children’s services.
History will not look kindly on a Government who promised so little and delivered even less. That is why I urge Members on both sides of the House to vote to support Labour’s motion. Abstention is a cop-out—join us in the Lobby.
The Parliamentary Under-Secretary of State for Communities and Local Government (Mr Marcus Jones)
This has been a wide-ranging and important debate on one of the most important social issues and challenges we face in our country.
Delivering good-quality care for our most vulnerable people is a clear priority for this Government. To ensure local government has the resources to fund adult social care through to 2019-20, the Government have given councils access to £9.25 billion of dedicated funding for adult social care over the next three years.
Beyond the immediate term, there is also the need to address the challenges of social care for our ageing population. Therefore, the Government will bring forward proposals for consultation, to build widespread support for reform. The consultation will set out options to improve the social care system, put it on a more secure financial footing, support people and their families to prepare for old age, and address issues related to the quality of care and the variation in practice.
Overall, local government spent £14.9 billion in 2016-17 on adult social care—up by £500 million from 2015-16, and over £500 million more than budgeted for. This year, councils are budgeted to spend £15.6 billion.
The Government continue to provide local government with the additional resource it needs to deliver care. At the spring Budget, an additional £2 billion of funding in England was announced, of which £1 billion has been provided in 2017-18. That was in addition to the resource made available in the local government finance settlement, where we provided £240 million for adult social care. It was also in addition to the £2.5 billion put through local authorities in the improved better care fund.
Alongside Government funding, more flexibility has been provided. Local government has been able to raise more income through the adult social care precept, with the flexibility to increase it by 3% this year. That adult social care flexibility was subsequently used by 147 out of 152 social care authorities, with 109 using the full allocation, or close to the full allocation, of 3%. I should point out that it is also down to the Government that, overall, council tax remains lower in real terms than it was in 2010.
In terms of the integration of health and social care, we should remember that the better care fund is the first national mandatory integration policy. We should not shy away from the fact that integration is not easy, but the Government are supportive of the best-performing systems, where local government and the NHS work together to tackle the difficult issue of delayed transfers of care. We understand that delayed transfers of care are only one part of what authorities deal with to deliver social care in communities up and down the country, but we also understand that improving working between local government and the NHS is absolutely key to delivering better joined-up care for local people.
It is also right that, in November, we will consider a review of the 2018-19 allocations of social care funding provided at the spring Budget 2017 for areas that are not performing well. We expect that that would encompass only a small number of local authorities, although we are clear that the funding will remain with local government to be used for adult social care. We also favour, if needed, the option that places conditions on how a proportion of the 2018-19 funding is used to support an authority’s delayed transfer of care performance.
Mr Jones
I will in a moment, but I want to make a little more progress and mention some of the people who have spoken in the debate.
The hon. Member for Denton and Reddish (Andrew Gwynne) finally hit the nail on the head right at the end of his speech in saying that we needed to approach this important, difficult and delicate subject in a non-partisan way. I was very disappointed, though, that 98% of his speech was spent on the politics of fear and, in some ways, misinformation. That was very much out of kilter with much of the debate across the House.
My hon. Friend the Member for Totnes (Dr Wollaston), the Chair of the Health Committee, made some very important points. She was absolutely right first to pay tribute to careworkers and carers—that is absolutely the right thing for us to do. She mentioned the remuneration of care work, as did other hon. Members across the House. It is important to point out that careworking is an extremely important job. The national living wage, which was £5.93 an hour in 2010, is now £7.50 an hour, and lower-paid workers pay £1,200 less in income tax than they did in 2010. We are well on the path to rewarding careworkers far more than they have been in the past, although we would acknowledge that there is more to do.
Barbara Keeley
If the Minister values care, would he comment on untrained members of the public being offered £1,000 a month to rent out rooms as an alternative to care for patients recovering from surgery? Do he and his Government support that, because it is frightening from a safeguarding point of view?
Mr Jones
It is important that we always have workers who are trained, and we are providing care in good-quality settings. We heard several times that 80% of our care homes are providing quality of care that is either good or outstanding.
My hon. Friend the Member for Totnes mentioned the integration of health and social care, and the importance of the health service in the context of the review that is going to be done. She spoke about future planning of the workforce, which is also very important.
The hon. Member for Leicester West (Liz Kendall) made some very sensible points and comments about the politics of dealing with long-term funding of social care, and said that it does not serve people or their carers if we are partisan. Even so, she slipped into a bit of partisanship towards the end, showing how difficult this situation is. On the whole, however, she made some very sensible points.
My hon. Friend the Member for Erewash (Maggie Throup) was right to point out that this is a long-standing issue that many Governments over decades have ducked. She mentioned the situation in Derbyshire with her council, which seems to have been left a difficult legacy by its Labour predecessor. I am certainly willing to meet her to discuss that issue.
My hon. Friend the Member for Halesowen and Rowley Regis (James Morris) mentioned the positive impact that the £2 billion of additional funding that was announced in the Budget for the adult social care precept has had in his area. He also made a sensible point about the potential for devolution to bring more integration between health and social care. My hon. Friend the Member for St Ives (Derek Thomas) said that health and social care is not just a responsibility for national Government because there is a responsibility on us all, particularly at a local level within the health service and in our local authorities.
My hon. Friend the Member for South West Bedfordshire (Andrew Selous) raised the importance of suitable accommodation to enable older people to live independently and help us to avoid many of the healthcare costs that we face. My hon. Friend the Member for Yeovil (Mr Fysh) mentioned the pressure that the national living wage puts on the system. It is quite right that we pay our careworkers more, and that is why we have given councils access to up to £9.25 billion of extra funding by 2020.
Many positive speeches were made during the debate, but unfortunately I have not got time to mention them all. The problems in social care have developed over many decades. The Government are absolutely right to recognise the challenges of adult social care and tackle them head-on. That is why we have provided further funding up to 2020. We need to address the issue, and that is why we will work across the sector to bring about change and a sustainable solution for the future so that the most vulnerable in our society can get the care that they deserve and need.
Question put and agreed to.
Resolved,
That this House notes the Conservative Party’s manifesto commitment to a funding proposal for social care which would have no cap on care costs and would include the value of homes in the means test for care at home; further notes that this proposal would leave people with a maximum of only £100,000 of assets; calls on the Government to confirm its intention not to proceed with this commitment; and further calls on the Government to remove the threat to withdraw social care funding from, and stop fines on, local authorities for Delayed Transfers of Care and to commit to the extra funding needed to close the social care funding gap for 2017 and the remaining years of the 2017 Parliament.
Barbara Keeley
On a point of order, Madam Deputy Speaker. Again we see the Government refusing to vote on a motion—[Interruption.]
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. I cannot hear what the hon. Lady at the Dispatch Box is saying, and she is speaking to me.
Barbara Keeley
Thank you, Madam Deputy Speaker. Again, we see the Government abstaining—refusing to vote on a motion tabled by the Opposition. This time, we have been debating vital issues: the funding crisis in social care and whether the Government will confirm their intention not to proceed with the policy for funding social care that they put forward, frightening people, during the general election.
My hon. Friend the Member for Denton and Reddish (Andrew Gwynne) has just described this Government as the “weakest and most divided” for many years. May I ask you, Madam Deputy Speaker, whether it is in order for this weak and divided Government to pick and choose when they will vote on matters that are raised in this House?
Madam Deputy Speaker
The hon. Lady has taken this opportunity to make the points that she wishes to make, and the House has heard them. She knows, and the House knows, that the Government’s decision on what they answer, what Ministers say at the Dispatch Box and how individual Members of this House choose to vote—or not—are not matters for the Chair. We will have no more points of order on that; it is not a point of order.