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—
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.