The Minister for Care (Caroline Dinenage)
I thank the hon. Member for Worsley and Eccles South (Barbara Keeley) for introducing the debate. We want this to be the best country in the world in which to grow old and in which people can face their third age knowing that they will be supported to live healthy, independent lives for longer and for as long as possible, with a choice of good-quality, affordable care that is there, should they need it. Today’s debate is a welcome opportunity to cover the action that this Government have taken to improve social care, highlighting a few examples where real progress has been made, as well as discussing our longer-term plans for the Green Paper, which will be published later this summer.
Most of all, however, I want to do something that the hon. Lady forgot to do, which is pay tribute to the extraordinary people—both the social care workforce and the informal carers—who play such a vital part in our health and social care system. At the heart of their endeavours is the commitment to do all they can to support individuals and families throughout the country.
Barbara Keeley
The Minister has just said that I did not pay tribute to informal carers. That is just not true. Everybody who knows me knows that I have never stopped paying tribute to informal carers, and I did so in my speech today. Please will the Minister not attribute comments to me that I did not make?
Caroline Dinenage
What I actually said was that the hon. Lady forgot to pay tribute to the social care workforce, who play such a vital part in our health and social care system. At the heart of their endeavours is the commitment to do all they can to support individuals and families throughout the country to live healthier lives with comfort, dignity and respect. However, it is absolutely right to begin by acknowledging that this sector has been through some really difficult times.
Norman Lamb
The hon. Lady is right to pay tribute to informal carers, and indeed to paid carers, but does she not feel uncomfortable with the fact that she and all her colleagues on the Conservative side legislated with us to introduce a cap, committed in 2015 to implement the cap, then abandoned it, thus abandoning the very informal carers she says she cares so much about?
Caroline Dinenage
We have not abandoned the cap. The Prime Minister said very clearly that we would continue to consult on the cap, and that will come forward as part of our plans for the Green Paper later in the year. We in this Chamber often hear about Labour’s recession and how it led to some hard decisions about public spending to get the country back on track, but we often forget—
Caroline Dinenage
Let me make a little progress, then I will happily take the hon. Lady’s intervention.
We often forget that we inherited not only difficult spending choices but a social care system that was on its knees because successive Governments—not just Labour—had failed to act. Labour acknowledged the problem in its 1997 manifesto, promising to find a solution. However, 13 years later, after one royal commission, two Green Papers and the 2007 spending review pledging to address the situation, Labour left office without delivering it. Worse than that, by the time Labour left office, despite the booming economy, council tax had doubled and every year 45,000 older people were forced to sell their home to pay for residential care costs.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Let us get back to the present day, because that is what we are debating. Disabled people of working age make up more than half of adult social care users. Given that the UN condemned the Government’s breaches of the convention on the rights of persons with disabilities, particularly article 19 on independent living, what does the Minister estimate to be the impact on independent living for disabled people of the cuts to social care?
Caroline Dinenage
If the hon. Lady will bear with me, I will come on to discuss that, but there will be a separate, parallel workstream on working-age adults, who account for over half of the spending—
Caroline Dinenage
If the hon. Lady will give me the courtesy of allowing me to finish my comments, I will explain why in a moment.
The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) wondered why we are going back to the past and looking at Labour’s record, but Labour is asking people up and down the country to vote for them in the local elections, so they will rightly look at Labour’s record and at how it dealt with the social care crisis when it was in government. After 13 years of inactivity and bluster, people need to be able to make a choice based on historically accurate facts.
Caroline Dinenage
The hon. Lady had plenty of time to make her comments, so I will make a little progress.
When the Conservative party formed the coalition Government in 2010, it is worth remembering that not only did we have to deal with the parlous state of the country’s finances, but we inherited a burning platform of social care. Of course, that meant taking difficult decisions in those early years, which were challenging times for local authorities.
Caroline Dinenage
I will be coming on to the cap later.
To give the Labour party its due, it recognised that we had difficult decisions to make. Had Labour stayed in government, it planned £52 billion-worth of cuts to local government budgets by 2015. However—enough of the history lessons—I intend to make progress and answer many of the shadow Minister’s questions.
Several hon. Members rose—
Caroline Dinenage
If hon. Members will bear with me, I will now make some progress.
The tough spending choices that we have made have paid dividends, meaning that we have turned a corner in recent years. That is why local government will be able to increase spending on adult social care in real terms in each of the next three years. Our population is growing, ageing and diversifying. At the same time, the money, means and methods that we deploy to serve their long-term health and care needs are under increasing pressure to deliver, and we need to address those issues now.
There is recognition across the House that even if we had an infinite amount of money to fix the problem, the system would need reform. We are taking steps to make the system more effective and to ensure that it better serves the needs of vulnerable people and society in general. That is why this summer’s Green Paper will complement those measures and ensure that our social care system is placed on a sustainable footing and will serve this nation for generations to come.
The Secretary of State recently outlined the seven key principles guiding our thinking on social care as we approach the Green Paper: quality, whole-person integrated care; control; workforce; supporting families and carers; a sustainable funding model for social care; and security for all. As I have said, this is not just about older people. The Green Paper will cover a range of issues that are common to all adults with care and support needs, but we are committed ensuring that any issues relating to social care that are specific to adults of working age are identified and given the right focus. Work on that is being led jointly by the Department of Health and Social Care and the Ministry of Housing, Communities and Local Government.
I will reflect on some of the Green Paper’s themes, but first I will highlight a couple of areas where real progress has been made. I have said that we know there is growing pressure on local authorities’ finances, but it simply is not true that this Government are failing to deal with or acknowledge the crisis.
Yasmin Qureshi
The Minister talks about trying to use finances appropriately. My local council has had a 54% cut to the funding that it receives from central Government, which is why it has a shortfall in funding for social care.
The Government have been able to find money to cut corporation tax, capital gains tax and inheritance tax, as well as £1 billion for the Democratic Unionist party. Are they really saying this is all about austerity and choices? Is it not really that the Government have different priorities from the Opposition?
Caroline Dinenage
I can honestly say with my hand on my heart that the Labour party does not have a monopoly on care or kindness.
I mentioned earlier that local authorities will receive a real-terms, above-inflation increase in their funding profile. We have announced significant dedicated funding for social care. The Opposition regularly seem to forget that we allocated an additional £2 billion to social care only a year ago, with a further £150 million this year. That means councils have access to £9.4 billion of dedicated funding.
Thelma Walker
Kirklees Council has had its funding cut by central Government by nearly £200 million. This year, it has raised its council tax by 5.9% to help pay for services. The three percentage points for social care come to £4.8 million, but there is a shortfall of £12 million a year. Can the Minister tell councillors where the rest of the money for social care should come from?
Caroline Dinenage
We are looking at the long-term sustainability of adult social care funding, and there will be more news in the Green Paper later this year. The last Labour Government had 13 years without dealing with the here and now, so I will take no lessons from them.
Several hon. Members rose—
Caroline Dinenage
I will make a bit of progress.
The shadow Minister asked about Allied Healthcare. She is right to raise that, and I am grateful that she has done so. As she said, Allied Healthcare announced last Thursday that it is proposing a company voluntary arrangement to its creditors. I want to talk about that specifically because people across the country will be concerned. I spoke to the chief executive officer last Thursday to emphasise the importance of continuity of care for everyone receiving its services, both in adult social care and primary care, and the company has made it clear that those who receive services from Allied Healthcare will continue to receive the same level of care and that their care plans will not change.
Barbara Keeley
I am glad the Minister has responded in that way, but I asked her how she would ensure that 150 councils can fulfil their statutory duty to provide care if that company goes bust. We need to know a bit more than that she has had verbal reassurance. Of course the chief executive, in his current position, will try to give her verbal reassurance but, under the CVA, the creditors have to be satisfied within four weeks. What is going to happen if this company goes bust? Is it going to be another Southern Cross?
Caroline Dinenage
I am happy to answer the hon. Lady’s questions, which she is right to ask. Although we are very hopeful that this procedure will have a positive result, we are taking steps to ensure we are prepared for all eventualities. The Care Quality Commission and my Department are monitoring the situation, and the CQC will notify local authorities in the event it considers it likely that services will be disrupted as a result of business failure. The law means that local authorities will step in to meet individuals’ care and support needs if a care provider business fails and its services are disrupted. The relevant local authorities are working up contingency plans to ensure individuals’ care and support needs continue to be met.
While the long-term options are being resolved, it is right that funding for social care comes from a variety of sources, including business rates, general taxation and the social care precept. Delayed transfers of care is one area where that money is clearly making a difference. This Government are clear that no one should stay in a hospital bed for longer than is necessary; doing this removes people’s dignity, reduces their quality of life and leads to poorer health and care outcomes.
Maria Caulfield
My local East Sussex County Council is a rural authority, so for decades it has had 49% less funding per head of population, yet it has had the same pressures as the areas represented by Opposition Members. By working together with health services, my council has reduced delayed discharges by 38%. Will the Minister welcome the hard work of East Sussex County Council?
Caroline Dinenage
I do welcome it. I recognise the very hard work of local councils that have managed to reduce delayed transfers of care. Indeed, I also recognise the very hard-working NHS staff, such as my hon. Friend, who have also helped to make that a reality.
We know that the NHS is busier than ever before, with hospital admissions rising by 33% since 2007, yet we have set clear expectations for reducing delayed discharges. Despite these challenging circumstances, both the NHS and social care have been working hard to free up beds. Since February 2017, more than 1,600 beds per day have been freed up nationally. I need slightly to take exception to the way the hon. Member for Worsley and Eccles South described people being discharged before they are medically fit. If someone is experiencing a transfer of care that has been delayed, it is because a multi-agency team have already assessed them as being medically fit for discharge.
John Redwood
Following on from the point about the big variations in how much per head councils get, may I point out that some time ago West Berkshire and Wokingham were cut back because they were very efficient and doing a good job? Will the Minister make sure that in the new formula good conduct is taken into account and does not lead to penalties?
Barbara Keeley
The Minister is just proving that she was not listening to what I was saying. What I said was that the British Red Cross has said that it had found innumerable cases where discharges have happened so quickly that people were discharged without the right amount of care, and that can just lead to a cycle of readmission. A constituent told me that, in the case of Salford Royal, which is an excellent hospital, she felt she had been “thrown out of hospital.” That is what she told me.
Caroline Dinenage
I very much thank the hon. Lady for that clarification.
Our funding increases have gone into initiatives such as the better care fund, which provides a mechanism for local authorities and clinical commissioning groups to pool budgets for the purposes of integrated care.
Caroline Dinenage
I hope my hon. Friend will not mind, but I want to make a little progress. The fund has 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.
Another area where we have made significant progress is quality and safeguarding. The Care Act 2014 placed adult safeguarding on a statutory footing for the first time and established a national threshold that defines the care needs that local authorities must meet. This eliminates the postcode lottery of eligibility across England. Last year, local authorities in England advised more than 500,000 people how to access services to meet their care needs—this includes services provided by leisure, housing, transport and care providers, as well as voluntary groups.
Everyone is entitled to, and deserves, quality care, and we are working to improve the terms and conditions for people accessing care, to ensure that their rights are protected.
Norman Lamb
On the sleep-in allowance, is it reasonable to expect providers to fund these back-pay claims, given that at the time the liability was incurred commissioners and providers entered contracts on the basis of what the Government said was right in terms of the minimum wage? When the Government change the position, surely it is not fair on organisations, private or third sector, retrospectively to expect them to pay.
Caroline Dinenage
I understand and share the right hon. Gentleman’s concerns on sleep-ins, and will be addressing this a little later in my comments.
We have established adult safeguarding boards to help to protect vulnerable adults in our society from abuse or exploitation. They can also act as an important source of advice and assistance for those using the adult safeguarding system. This Government also introduced the toughest system of care home inspection in the world. Eighty-one per cent. of adult social care providers are good or outstanding according to the CQC, which is a testament to the many hard-working and committed professionals working in care, to whom we owe a huge debt of gratitude. The CQC regime is already having a positive impact and 82% of providers who are rated as inadequate go on to improve.
Regardless of that, there is too much variation in the quality of care. Neighbouring local authorities can have radically different success rates on care quality and we are taking steps to address that. We are working with the adult social care sector to implement Quality Matters, a shared commitment to take action to achieve high-quality adult social care for service users, families, carers and everyone working in the sector.
We welcome the Competition and Market Authority’s recent market study on care homes. It makes difficult reading, but we have welcomed it and as part of developing the Green Paper the Government are carefully looking at all the issues identified. What is more, we have published a package of measures to improve consumer protections in the social care sector after the CMA raised concerns about unfair consumer practices in homes, including the charging of unfair fees to residents and the lack of contractual and pricing transparency.
Those measures, which include working alongside industry to develop model contracts and supporting the CQC to better hold providers to account, aim to put the power back into the hands of residents and their families. We are clear, however, that if improvements are not seen we will look to change the law to strengthen protections so that people can be treated with the dignity and respect they deserve.
That leads me to the third aspect on which I want to focus. Ultimately, the social care workforce are the backbone of the care sector. We know that there are challenges and that is why we need to ensure that they are supported to deliver the best-quality care now and in the future. Part of that endeavour involves respecting not only the compassion and dedication of care workers but the vast range of skills they have. Alongside social workers, occupational therapists and nurses, we have many care workers who could benefit from or be inspired by new career progression ladders. We need to ensure that we have enough people within all those skilled roles to support individuals and families in living their best possible lives. That means ensuring that new routes into social care professions have as much variety and value as those developed by the NHS. Apprenticeships are part of that story. I am proud that in 2016-17 more than 90,000 social care apprentices began their training. That is up more than 40,000 compared with in 2010.
Of course, pay remains a constant and often emotive issue. Care workers deserve a wage that reflects the true value of their work. The national living wage is, in part, a reaction to that and the average salary for a care worker in the independent sector has gone up by 4%, with those full-time staff on the minimum wage seeing a pay rise of up to £2,000 since 2015. We are not complacent about the economic pressures faced by many in the system, but that is a good place to start.
A couple of hon. Members have spoken about sleep-ins and they are absolutely right to raise that. The Government are committed to creating an economy that works for everyone, ensuring that workers are paid fairly according to the law, including through the national minimum wage, but we recognise the pressure that has been placed on the sleep-in sector by historic liabilities for back pay. We are carefully exploring options to minimise any impact on the sector caused by this and have been engaging with the European Commission to ensure that any response would be legal. The Government will continue to work with representatives of the social care sector to strengthen the evidence base, building on the work we began over the summer. I will, of course, keep the House informed when we have made progress.
There are thousands of care workers in England, and we need many more, but it is true that we already have hundreds of thousands of carers out there—the unpaid hidden army of family, friends and community volunteers without whom the system would simply grind to a halt. We know that about 60% of us are likely to become carers at some stage in our lives. As it is today, one in eight of the adult population is a carer. That is why carers will be a fundamental part of the Green Paper. A sustainable settlement for social care will simply not be possible without focusing on the support we provide to them. Ahead of the Green Paper’s publication, we will shortly publish an action plan on carers, setting out a cross-Government programme of targeted work to support carers over the next couple of years.
Another principle that the Secretary of State has spoken about in the context of the Green Paper is control. We know that the greater control people have over their care, the better the outcomes. The only people who have a specific right to have a personal health budget are adults in receipt of NHS continuing healthcare or children receiving continuing care, which is why earlier this month we launched a consultation on extending the right to personal health budgets and integrated personal budgets to achieve better outcomes for those with the greatest ongoing social care needs as well as health needs. Those are some of the principles that are guiding the Green Paper. The goal is that, whatever a person’s age, they can be confident in our care and support system, not just for their own health and care needs but for those of the people close to them.
Karin Smyth
The 2015 Tory manifesto was very clear on the commitment and the assurances about the cap. The 2017 manifesto abandoned that. I think the Minister said earlier that it is still part of the Government’s considerations. Will she clarify from the Dispatch Box today what we are to expect in the Green Paper with regard to the cap?
Caroline Dinenage
The Prime Minister said last year in the general election that we would be consulting on the cap in due course and that will be part of the Green Paper. Building a sustainable care and support system will require some big decisions, but getting this right promises a better system in which everyone can have confidence, where people understand their responsibilities, can prepare for their future and know that the care that they receive will be to a high standard and help them to maintain their independence and well-being. The paper will set out options to put the social care system on a more secure footing and address issues to improve the quality of care and reduce the variation in practice.
Several hon. Members rose—
The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
I should open with a thank you to those Members who have made some very thoughtful contributions to today’s debate. We recognise the challenge we face, and the hon. Member for Central Ayrshire (Dr Whitford) put it most strongly when she said that it is the result of something very positive: that we are all living longer. That requires some serious strategic thought about how we fund social care. It is in that spirit that we are rising to the challenge.
Both Opposition Front Benchers, the hon. Members for Worsley and Eccles South (Barbara Keeley) and for Denton and Reddish (Andrew Gwynne), expressed their dissatisfaction with the speed with which we are pursuing these reforms, but it is important that we get it right and that we take people with us. With that in mind, we have put together an advisory group to work with on the reforms. The whole sector is co-operating with us and actively contributing to the debate, because it more than anyone recognises the need to fix this and get the solutions right. I make no apologies for the fact that we are where we are now, but we are well down the track with the process. In the spirit of cross-party consensus that I have heard a lot about this afternoon, I will not get into some of the partisan points that have been made, but I want to set the context of where we are with the debate. When we introduce the Green Paper, I hope it will be received in the spirit of the comments that we have heard from most hon. Members today.
Debbie Abrahams
The Minister who opened the debate was unable to respond to my question, so I will repeat it to this Minister. What assessment have the Government made of the impact of social care cuts on the ability of disabled people to live independently, and will she apologise to those disabled people for what the UN has described as this Government’s “grave and systematic violations” against disabled people?
Jackie Doyle-Price
To be frank with the hon. Lady, one of our priorities is to make sure that disabled people can live independently for longer. That is very much a central part of our approach and we are making more money available for it. [Interruption.] She can sit and smile, but that informs our approach.
I should also like to associate myself with the comments made by a large number of colleagues in paying tribute to the hard-working, committed people who make up our social care workforce and to the informal carers who play such a vital part in our health and social care system. Central to the points made by the hon. Members for Stretford and Urmston (Kate Green) and for Keighley (John Grogan) is that we all collectively need to send a clear message that the work that those people do is valued. We are working with Skills for Care to put more value on this as a profession. People who work in the care sector do so because they are personally motivated and money actually matters less to them. We ought to give them a clear message that we really appreciate all the efforts that they make.
Many Members have raised the issue of funding cuts to council budgets. That subject obviously informed the comments from the hon. Member for Denton and Reddish just now. I will not run away from the fact that there have been challenges for councils in recent times— [Interruption.] Opposition Members mention cuts, but the bottom line is that we can only spend what we collect from taxpayers. That is the reality of the situation. I will be first in the queue to pay tribute to those councils that have stepped up to the challenge, coped well with the reductions and worked hard to become efficient. They have shown real innovation in rising to the challenge.
Andrew Gwynne
I fully appreciate the Minister’s point that we can only spend the money that we raise from taxes, but this is a question of priorities. Why did she vote for a £5 billion cut to the bank levy in the Budget? Is that not the wrong priority?
Jackie Doyle-Price
I think the hon. Gentleman will find that we actually have a very progressive tax paying system none the less.
I want to celebrate those areas that have continued to deliver their social care responsibilities in challenging circumstances. We have heard a lot about what has gone wrong, but let us just remember this statistic: 81% of people in care homes are in homes that have been rated good or outstanding. I think that is an achievement, and something to be celebrated. I also want to compliment those councils that have really stepped up to the plate to deliver an improved performance on delayed transfers of care. Stoke and Trafford in particular have cut their delayed discharges by more than half. This comes down to leadership and determination. Where councils show real leadership, that will deliver improvements and change—[Interruption.] I have just named those councils: Stoke and Trafford.
Kate Green
The Minister is right to say that we are making progress on delayed transfers of care, but the figures have been very high. It really comes down to the fact that we just do not have enough well-funded places to enable people to be discharged from hospital quickly and get into the care in the community that we all want them to have.
Jackie Doyle-Price
I do not disagree with that point. That is why we need to embark on a process of reform and really get it right. We are embarking on the process on that basis.
A number of Members, including the hon. Member for Blaydon (Liz Twist), mentioned sleep-ins, and I just want to restate what was said, because it seems to have been misunderstood. We fully recognise the pressure on the sector resulting from the ruling on sleep-ins and the fact that the historical liabilities could be a problem. We are working closely with providers, in liaison with the European Commission, to come up with a solution. Hon. Members will understand that the matter is too commercially sensitive for me to say any more than that—[Interruption.] We are working with providers and meeting them on a regular basis.
Liz Twist
I understand what the Minister has just said about sleep-ins and that she is working with providers. We all understand the pressure on those providers, but I asked earlier, are we looking at a way to reward the staff properly for the work they do during sleep-ins, or are we trying to avoid the question?
Jackie Doyle-Price
The ruling from HMRC is clear that those on sleep-in shifts are still entitled to the minimum wage, so we are working out a solution to those historical liabilities. We are clear that we expect all employers to abide by the national minimum wage legislation, and I hope that that gives the hon. Lady some clarity on that point.
We can expect the Green Paper to be brought forward, but I also want to address what Members have said about the variation in quality and availability of provision. As has been said, local councils are responsible for responding to that, and the CQC has rated 81% of care services as good, but it is important that we work with those that are performing less well to achieve significant improvements so that everyone is entitled to the best possible care.
I was pleased to hear the contribution of my right hon. Friend the Member for Ashford (Damian Green). His philosophical approach perhaps reflects the amount of time that he has spent thinking about this topic. I associate myself with the comment made by him and several Members across the House about the fact that no one has an unblemished record when it comes to debates about social care. If we are genuinely to come up with a long-term solution, we need a spirit of consensus to take people with us, and people on both sides of the House need to remember that.
In conclusion, we have had a full debate and it will not be the last time that we debate this subject. We are now quite a way down the track when it comes to working up real proposals to bring genuine reforms of the social care system to equip ourselves for a world where life expectancy ends not at 70, but at 100. That will require significant change. We are stepping up to the challenge and will bring forward proposals in due course.
Question put and agreed to.
Resolved,
That this House notes that Government cuts to council budgets have resulted in a social care funding crisis; further notes that Government failure to deal with this crisis has pushed the funding problem on to councils and council tax payers and has further increased the funding gap for social care; is concerned that there is an unacceptable variation in the quality and availability of social care across the country with worrying levels of unmet need for social care; and calls on the Government to meet the funding gap for social care this year and for the rest of this Parliament.
Barbara Keeley
On a point of order, Mr Speaker. The motion that has just been unanimously agreed calls on the Government
“to meet the funding gap for social care”—
widely said to be £1.3 billion—
“this year and for the rest of this Parliament.”
Given that Ministers have agreed to the motion, can you advise when we might expect an announcement from the Government on this important agreement on social care funding?