(1 year, 9 months ago)
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Mr Clive Betts (Sheffield South East) (Lab)
I thank everyone concerned for the opportunity to lead this debate on behalf of the Levelling Up, Housing and Communities Committee. Adult social care is an important issue, which the Committee has come back to on several occasions.
Last year, we produced another report on long-term funding for adult social care. We were happy to receive letters, in the last couple of days, from the Under-Secretary of State for Levelling Up, Housing and Communities, the hon. Member for North East Derbyshire (Lee Rowley), and the Minister for Health and Secondary Care, the hon. Member for Colchester (Will Quince), both saying why they have not yet responded to the report that was produced around nine months ago.
As you know, Mr Speaker, the advice is that Government should respond to Select Committee reports within eight weeks, so eight months seems rather a long time. I know that there have been quite a few changes of Minister during that period, so perhaps that explains some of the delay. If this was just a one-off, it would probably be excusable, but the Select Committee rarely gets a response within months, let alone weeks, of a report being produced, which is a little frustrating when we have put so much effort into them. We have not even had a proper response to the joint report that we produced with the Health and Social Care Committee back in June 2018—almost five years ago, which must get near a record for non-responses to Select Committee reports. The Health and Social Care Committee has also done its own reports into these matters, as have many reputable organisations, such as The King’s Fund.
Given the nature of the debate, I will concentrate on the impact on local government funding. Although social care, as a responsibility, lies with the Department of Health and Social Care, it is ultimately delivered through funding from local councils. I want to concentrate on the challenge that that poses for councils. This is not a new matter and is not without a lot of commitments. Only last year, the right hon. Member for South West Norfolk (Elizabeth Truss) said that she would spend £13 billion raised by the levy on social care. Well, the levy seems to have disappeared into other uses, as has the £13 billion.
The right hon. Member for Uxbridge and South Ruislip (Boris Johnson) said:
“I am announcing now—on the steps of Downing Street—that we will fix the crisis in social care once and for all”.
Not to be outdone, the right hon. Member for Maidenhead (Mrs May) said that her Ministers
“will work to improve social care and will bring forward proposals for consultation.”—[Official Report, 21 June 2017; Vol. 626, c. 35.]
Let us go back a bit further. David Cameron said:
“A commission will be appointed to consider a sustainable long-term structure for the operation of social care.”—[Official Report, 25 May 2010; Vol. 510, c. 31.]
I will not just be party political in this, because Gordon Brown said:
“Alan Johnson and I will…bring…new plans to help people to stay longer in their own homes and provide greater protection against the costs of care.”
The one thing that Prime Ministers have in common over the years is that they all promise to deal with the problems and funding of social care. The other thing that they have in common is that none of them has actually done that, and that is something of concern and it is why we still have the problems today.
Let me put this in the context of local government funding. Local government has had the biggest cuts of any part of the public sector since 2010. The National Audit Office and the Library have produced some interesting figures, which are known to be authoritative. They have said that the cut in core spending power for councils in the decade after 2010 has been 26%. By comparison, the increase in funding for the Department of Health and Social Care has been 14%. So that is 26% down for local government and 14% up for the Department of Health and Social Care. I am not begrudging the extra spending on health, but, clearly, councils also do important work and that is not really reflected in the figures.
The reason for that cut in spending power is that the revenue support grant has fallen by 37% over that similar period. A 25% increase in council tax has helped cover some of that fall. Council tax spending as a percentage of total local government spend—the percentage funded by council tax—has gone up from 41% of local government spend to 60%. In other words, council tax has been going up as the Government grant has fallen, but the totality of spending has fallen as well.
Councils’ spending on social care—social care as a whole, including children’s care—has risen by 8.9% in real terms, but non-care spending by authorities has fallen by 32%. That is the knock-on effect—we must keep reminding ourselves of the consequences of this. Social care spending has now roughly risen from 50% of council spending to 60% over the period. Those are very dramatic changes in how councils spend their money.
Let us look at services such as planning. I know that they are important for the future of our country, for future growth and for regeneration. Spending by councils on planning has fallen by about 50%. That is a staggering fall. There have been similar falls in regeneration and economic development, which will be important for the levelling up agenda.
Let us look now at libraries, buses and street cleaning, which are important services that everyone tends to use in some way. They have all fallen by between 30% and 50%. The real challenge for local democracy—the Minister on the Front Bench has responsibility for local government—is that people are now finding that their council tax is going up by amounts that I have just described, but, if they or their immediate relatives do not use social care, they are seeing all the services that they receive fall. That is a fundamental challenge for local democracy—people pay more and get less. That is not defensible in the medium term, but it has been going on for 10 years now, and something has to give.
We might think, “Well, it’s alright as long as social care is sorted out,” but it is not, is it? Let us just look at the particular problems with social care and social care funding. Before the autumn statement last year, the Local Government Association said that it thought that about £7 billion was the shortfall currently. I appreciate that the Minister will no doubt advise us of all the goodies that were delivered in the settlement for the next financial year, and, clearly, there were some helpful increases of money, but not the £7 billion that local councils were looking for. The problem is that that settlement contains some of the elements of the problems that we have been experiencing for a decade or longer now. First, so much of the funding councils get is short-term. Yes, the better care grants and the social care grants are welcome, but much of it is on a one-off basis. Much of last time’s settlement was on a one-off basis, with the extra money coming in those forms of grants, together with the increases in council tax I mentioned previously.
We know there are two fundamental problems with increases in council tax: first, they raise far more money in the most affluent communities than in the poorest communities, and secondly, they are regressive—not my word, but the Secretary of State’s. I know the Minister has been charged with finding a solution to that problem. Good luck to him—we look forward to his report in due course, and we had an interesting dialogue with him in the Select Committee the other week. We are asking more from people on low incomes with proportionately lower house values, and giving less to the poorest communities through the increases. That is not the best way to fund social care in the longer term.
We know that, although funding has been going up, demand is rising. There are more unhealthy people in our communities, as we all know; we can see the figures for ourselves. Often forgotten, however, is the rising demand from people with disabilities. People with a whole variety of disabilities, both learning and physical, are living longer. Where they might have died in their 30s, they are now very often living into their 50s, to the point where parents who once looked after them can no longer help or support them. Those parents are worried sick about what will happen to their children when they no longer have that parental support available. That demand must also be met and recognised.
Barbara Keeley (Worsley and Eccles South) (Lab)
Will my hon. Friend reflect on the fact that, when local authority spending on social care is squeezed and the demand goes up, as he describes so well, the work of caring is then passed on to unpaid carers, such as the parents of the people with disabilities he talks about? Last week, the King’s Fund reported that the number of unpaid carers receiving direct support from local authorities fell by 7% from 2020 to 2021. Does he agree that unpaid carers are being failed by this squeeze and the inadequate local authority funding, and that the Government need to do more to improve that and ensure that carers are properly supported?
Mr Betts
That is a great point from my hon. Friend. We recognise that that care is generally provided with a lot of love and commitment from people who do it, but very often they will reach breaking point without the additional support from local authorities, such as respite care. Families say to me, “If only I could just have a week where I could go away and relax a bit, knowing the person I am caring for is being looked after, that would make an enormous difference.” Sometimes that does not exist anymore, so that is an important point.
Bob Blackman (Harrow East) (Con)
The hon. Gentleman is giving a very clear explanation of local government funding, and I would expect nothing less from the Chair of the Select Committee. However, there is another issue he has not yet covered in his speech, and I am not sure whether he plans to: does he agree that another problem is the other source of income for local government, non-domestic or business rates? I well remember a certain hon. Lady from the Opposition saying in the Select Committee that we are going to get to a position where the non-domestic rates are paying for social care. Is that the right way to utilise business rates?
Mr Betts
The hon. Gentleman makes a good point, and he has been through some of those discussions on the Select Committee—I think the County Councils Network also made that point strongly to us—so he is absolutely right. I was not going to go too much into the long-term reforms of local government funding, but as a Committee we have said that there is a real challenge with the reforms of both council tax funding and business rates, and we have produced reports on that. There is not a clear linkage between how much money a council might get in from business or non-domestic rates and how much demand for social care is going up. Demand for social care is going up that much faster and the tax base needs to be adapted to recognise that, so his point is an important one.
To some extent, that demand is being met by tightening the rules on exemptions. More and more people who would have got social care in the past do not get it now. Age UK says it is 1.5 million—an estimate, but probably not an unreasonable one. There is also less prevention work going on, which means that people who have small needs to help them live in their homes do not get those needs addressed until they become serious needs. Then they end up in hospital, which is much more expensive and a much worse outcome for the people concerned. It results in more pressure on the NHS, more cost and a less good service.
On the other hand, there is the pay and conditions for care staff. People doing the same job in care get less money than people in the NHS. That is true of nurses, for example, where we can make direct comparisons. We know that up to half of care staff tend to leave within a year, and many are on zero-hours contracts. There have been repeated requests for a long-term workforce plan. There has rightly been a request for a long-term plan for the health workforce, but we need one for the social care workforce as well. I think that the Chancellor, the right hon. Member for South West Surrey (Jeremy Hunt), when he chaired the Health and Social Care Committee, argued that case very strongly, and quite rightly.
There is a question of pay: these are skilled people with a real commitment that should be recognised, and not at a minimum pay level. There should be a system with proper career progression and training, so that people can realise the benefits of their skills and commitments. There is evidence that the care market is broken, that many care providers have gone out of business or struggled over the years and that the level of fees in some areas probably does not reflect their costs.
Then, of course, we have the issue of people having to give up their homes to pay for their care costs. It is a complete lottery. If in the end someone finishes the last years of their life with dementia, much of the value of their home will go to pay for their care. If they finish their life by having a heart attack and dying, they do not pay anything towards their care. That is an unfair system and it needs to be addressed. The Dilnot reforms have been around for some time. They have been nearly started and then not started, and nearly started again and not started; I will refer in a couple of minutes to how we might take things forward.
How might we change things to improve them, then? This debate is not just about making complaints; it is about providing solutions. I accept that, and that is what the Select Committee is trying to do. One suggested solution is, “Well, just amalgamate it—let’s have one big service. Put it all in the NHS and it’ll all be all right.” I think most would say that the NHS has enough challenges at present without taking on another great challenge on top. What we do not need is another mass reorganisation affecting both health and social care, the cost of which would probably be a lot more than the cost of doing things any other way.
We should also remember that most people receiving care receive it not in a hospital or even in a care home, but in their own homes. The link that councils can make between their home service, providing adaptations and the like, and care, is key in that regard. The other thing I would say is that we cannot carry on relying on short-term fixes, with one-off grants here, one-off grants there, and a council tax system that is regressive and not fit for purpose, let alone for long-term funding of social care—or, as the hon. Member for Harrow East (Bob Blackman) said a few minutes ago, business rates, which bear little relation to demand for social care either.
I go back to the 2018 joint report with the Health and Social Care Committee, in which we said two things. We did a lot of work with the focus group on this question and spent a lot of time on weekends away in a hotel in Birmingham. What people said was, “If we knew the money was going to social care, we would happily pay more.” That is what happens in Germany and Japan, two countries that we looked at. We said, “Let’s have a social care premium.” Immediately, it might be said that that is not dissimilar to the Government’s proposed increase in national insurance rates. The difference was that, at the time, we said that we had to target any payments. There will be different ways of doing this, I accept, but there has to be a way of raising extra money for social care that neither comes from the current local government system, nor takes care out of local government.
We said that there should be a social care premium as a percentage of income, but that we would raise the bottom level so that the poorest people would not pay. We would increase the top level in the way that national insurance does not, so that people on the highest incomes would continue to pay, and we would include unearned income and higher-level private pensions, but we would also exclude the under-40s, as they do in Japan. We felt that people under 40 were probably getting the worst of the deal after the financial crash in terms of the impact on their finances. That is how we thought we could raise the funds, and it was agreed by the 22 members of the two Select Committees as a way forward.
What is sometimes missed, and what we also suggested, is that we have to deal with the issue of people’s homes being sold. I have to say to the Government that their arrangements to try to implement Dilnot are complicated and unfair. People may not pay until their assets reach a minimum level, but—and I have never heard a Minister address this point—the Government cap the amount that people pay in such a way that people with lower value houses pay a bigger percentage of their homes than people with the highest value houses.
Someone who has a home worth half a million pounds pays a much smaller percentage than someone who has a home worth £100,000. That is not fair, so our Select Committee said that a percentage should just be taken from everyone’s estate. Then, the people with the most would pay the most, and the measure would not be confined to people who need care. That removes the unfairness of people with dementia paying all or most of the value of their home while those who do not have dementia paying nothing. With a small amount of inheritance tax, or another way of assessing people’s estates, we could raise a lot of money and deal absolutely with the problem of people having to give up most of their home to pay for their care costs. That is certainly worth a look.
We need to find a long-term solution to the problem. It is not going to go away, is it? The number of elderly people will continue to grow; the number of people with learning disabilities will continue, quite rightly, to require more from our services. Councils said that the funding gap was £7 billion last year, but they have also said—the Health and Social Care Committee has addressed this, and other important think-tanks have confirmed it—that if we are to deal with the combination of problems, including the immediate funding gap, the need to address eligibility criteria and bring more people back into the social care system, the challenge to local government finance, and the need for a long-term workforce plan, the gap is probably about £14 billion. That is a big sum of money, and we cannot find it in the existing local government finance system, which cannot cope as it is.
If we carry on as we are, and demand keeps increasing with no improvements to eligibility or workforce pay, there will be a consistent further increase in the pressures on other local government services. There will be bigger cuts to libraries, buses, planning, street cleaning and so on. The public, in the end, will simply not stand for that. I say to the Minister: please, let us just have a bit of long-term thinking and recognise that this is a serious problem that will not go away. Local government funding, as it exists at present, cannot take the strain any longer. We need an alternative source of revenue, we need to keep social care linked in to the rest of local government services, and we need, of course, to develop better contacts with the health service. Money to deal with the problem of people sat in hospital beds when they need to be in social care is welcome, but all that is short-term thinking.
I say to the Minister—and, to be non-partisan, to the Labour Front Benchers—where is our plan for long-term care? Where is our recognition of the funding needs? How will we bring about change? Could we, as the Joint Committee said, just possibly get a bit of cross-party thinking on this for the future? Whatever solution we come up with, we need one that will work for the long term, not just for half a Parliament or for one Parliament.
Damian Green (Ashford) (Con)
May I start by saying how delightful it is to see you back in your proper place, Madam Deputy Speaker? You are very welcome back.
I congratulate the hon. Member for Sheffield South East (Mr Betts) not only on instigating the debate but on much of what he said. He said that he wished to speak in a non-partisan way, and he approaches the subject as the Chair of the Select Committee, while I approach it as the chair of the all-party parliamentary group on adult social care. I found myself nodding in agreement with significant amounts of what he said, particularly the point about the need for long-term thinking and for a quite radical change in the way that we fund adult social care.
That is not just agreed across the House now, but has been for some decades. The hon. Gentleman went as far back as Gordon Brown. I can go back further: I have identified Tony Blair talking to the Labour conference in the 1990s, saying that social care was one of the big issues that he wanted to address in government. Here we are, a quarter of a century later, and we have got through it with a series of short-term efforts and sticking plasters. Long-term plans have been produced and promised but none of them has ever been put into policy. Throughout that quarter of a century of debate, the one thing that has been agreed is that the social care sector needs long-term funding.
The current Prime Minister and Chancellor have understood the importance of a long-term strategy and funding base for the sustainability of adult social care. Indeed, as the hon. Member for Sheffield South East said, the Chancellor was previously—by happy chance— Chair of the Health and Social Care Committee, and that Committee produced a number of reports setting out the need for an additional £7 billion a year for social care. I note that the hon. Gentleman has just doubled that to £14 billion.
I am sure that the figure will rise, not fall; we have only to look at the demographics of the over-65s. Regardless of the rising number of working-age people who require social care of one form or another, if the same sort of percentage of over-65s end up requiring care, the bill will go up by something like 80% over the next 15 years. It is certainly true that demands on the social care budget will rise rather than fall in the coming years.
Mr Betts
Figures are bandied around, but I think that the figure is somewhere between £7 billion and £14 billion. It depends—the right hon. Gentleman is addressing this point properly—on whether we include the rise in demand, the need to have a real review of the workforce and pay, and the eligibility criteria. That is the way in which costs have been dampened in the past. We really need to revisit that whole issue.
Damian Green
I agree; indeed, I will mention workforce later.
The Government have, of course, responded to this issue in successive years, and have found extra central Government funds to pay local government, so we have proceeded from year to year, and although the system has been fragile, it has continued to operate. Of course, the background conditions are getting increasingly difficult. Inflation has an impact on social care providers. A cost of living survey done by social care provider MHA found that 94% of its community schemes had heard members or residents express concerns about the rising costs of living, and 49% of respondents said that the increased costs of transport specifically were a significant issue among their members. There is a danger that rising energy costs will significantly reduce the number of available services and have an immediate impact on discharge from the NHS into the community.
The Association of Directors of Adult Social Services has reported that nearly half of all directors of social care services are not sure that unpaid carers will be able to cope financially with the cost of living crisis, which could lead to further increased demand on paid-for social care services.
Sir Greg Knight (East Yorkshire) (Con)
My right hon. Friend is making an excellent speech. Does he agree that we still grossly undervalue carers?
Damian Green
My only caveat is that my right hon. Friend says “we”. In the community, we do not.
Damian Green
Publicly, as a country, we may well do so. They are a hidden army of people acting well, purely out of generous motives and the desire to help loved ones, which is natural. They do not get enough reward and praise from the general public, even though many of those people are the best members of the general public.
There are other specific measures that the Government could take. I would hope that following April, adult social care providers could be defined as a vulnerable sector as part of the energy bill relief scheme; I think that would be of significant help. The County Councils Network has estimated that with inflation, it could cost councils £3.7 billion extra to keep social care services running. If that figure is anything like accurate, the quality of care will decrease if those providers are not defined as a vulnerable sector.
I will now move on to the central point of the debate, which is funding. The hon. Member for Sheffield South East has very eloquently made the case for what we all know to be true: adult social care is a huge strain. The way in which we currently fund it is something that local councils find unsustainable, and therefore, the system is now kept going through repeated one-off injections of central Government cash. That in itself is not sustainable as a system. Some years ago, I suggested an alternative way of getting the extra money we all need into the system. I will return to that proposal now, because if we step back, the problem is that social care—especially for the elderly, perhaps—is too opaque for those trying to understand it, with no apparent logic as to which conditions receive free NHS treatment and which do not. Moving directly on to the financial point, it is also unfair not to reward a lifetime of prudence. Those who have saved feel that their savings will simply disappear, while those who have not saved receive the same level of care.
There is also the fact—which is not often discussed—that funding social care out of council tax means that local authorities are reluctant to allow too many care homes, or indeed retirement housing, to be built, because they do not want an increasingly elderly population. The ageing population means that something like 50% of some councils’ spending already goes on social care. As the hon. Member for Sheffield South East said, that figure is projected to rise to 60%, and given the demographic trends that I have already mentioned, my fear is that some higher-tier authorities that are funding social care will end up as basically social care providers with a few libraries and a bit of money to spend on potholes, and not much else. A lot of essential council services will be swallowed up by the need for social care, as well as the fact that the problems in social care put extra pressure on the NHS.
We need a radical change to the system in order to meet five objectives. The first is to provide enough money to cope with the increasingly ageing population. The second is fairness across generations, so that today’s working-age taxpayers are not asked to pay for both their own care in the future and the care of the generation above them today. The third is fairness among individuals, ensuring that no one has to sell their own home—has to lose all their assets to pay for care—and ending the dementia lottery that the hon. Member for Sheffield South East mentioned, where one condition is treated on the NHS and another is not. The fourth is increasing the supply of care beds and retirement housing. My fifth point is perhaps slightly ambitious: in an ideal world, we should secure cross-party consensus, with a lot of consultation before we move to a new system, but with the people moving to that system having confidence that Governments of any stripe will keep it going.
The model I take, because we can see it more or less working, is the pension system. The basic state pension has been increased significantly in recent years, taking many pensioners out of poverty, but at the same time, most people save additionally through their working years to provide comfort and security in old age. Auto-enrolment in pensions has been a great cross-party success story, encouraging millions more people to save towards their own security in old age; for an individual who starts saving in their early 20s, the benefits will not come for decades, but they will be huge when they arrive.
Similarly, just as the basic state pension has been improved in recent years, I think we should offer a universal care entitlement, offering a better level of care—both homecare and residential care. For those who need residential care, that would cover the core residential costs. The needs would be assessed locally, but the money would come from central Government, which would take away the pressure on local councils. The state element of that funding should come centrally, rather than locally. Will that involve extra money? Of course it will, but given the annual injections of extra money that the Government put into the system, they have already implicitly admitted that it needs much extra money, so I think this is a necessary increase in public spending. I accept all the pressures and controversies that it will cause, but it seems unavoidable to me.
On top of that, we need to find an acceptable way to allow those with the capacity to improve their own provision to do so. I suggest we should create what I call the care supplement: a new form of insurance designed specifically to fund more expensive care costs in old age, just like the private pension system that tops up the state pensions of millions of people. It would allow people to buy insurance at the level they can afford in order to provide peace of mind. I do not think that the care supplement should be compulsory, as indeed auto-enrolment for pensions is not compulsory, so we would not get into the slightly sterile debate about death taxes and dementia taxes, phrases that both of the main parties have thrown at each other over the years.
People could save for that insurance over many years through their working life, or they could make a one-off payment—possibly using something like equity release from a part of their house value—at a suitable time in their life. I will pause on that point, because too much of the social care debate has devolved into questions about home ownership and whether a person has to sell their home. Under a mass insurance system, nobody would have to lose all of their assets or sell their home; a sliver of the money that is now in free equity in housing owned by the over-65s would cope with this challenge. There is £1.7 trillion in free equity in housing owned by the over-65s, and if a very small percentage of that money were applied to insurance for social care, it would mean that people had peace of mind in old age.
I have been told by successive Ministers that that system would be too complicated, and that we cannot set up an insurance system. All I say in response is this: of course, setting up a new system is complicated and difficult, but we know that the current system is not working. If we carry on doing the same thing, the system will continue to be frail and rickety for years—possibly generations—to come, which is not acceptable. We have to do something radically different. If somebody can come up with a better way of getting some of that wealth to pay for social care, fine, but we have to try something radical.
Funding is one key issue, but since the debate is about adult social care, I will identify four areas in which we need new thinking if we are going to fix social care. The first is the workforce, which has already been mentioned. It needs to be bigger—bigger by more than 100,000—and to achieve that, it needs to be better paid and have a higher status. I would like nurses working in the care system to be on the same Agenda for Change pay scales as those in the NHS, otherwise they will keep moving from the care system to the NHS.
The second area is the voice of care within the new integrated care boards. That change represents a chance to improve the integration of the health and care systems without creating another massive bureaucracy, but I slightly fear that the ICB system is settling down with the voice of care providers not being loud enough at the table. Local authorities are clearly a key player in the system, but so are other providers, and their voice needs to be heard.
My third point is about the use of technology, not only for sharing information between different parts of the system, but for giving those in receipt of care more control over their daily life. We are not exploiting the range of available technology anything like enough to do that and, if we get it right, the prize is that more people will be able to stay in their own home for longer. That is better for them, most importantly, but it is also better for the taxpayer, so it ought to be a high priority. It is particularly important for people living with dementia.
The fourth area is an extension of that notion of people staying in their own homes for longer through the provision of housing. As it happens, in one of the Minister’s previous incarnations, I spoke to him about this issue. We are failing to build anything like enough supported housing for older people, particularly in retirement villages. Taken together, the last two measures I mentioned—technology and the provision of suitable housing—would mean that many people were able to stay in their own home for longer. As I say, that is a double win: it is better for the taxpayer, but most importantly, it is better for people as well. Most people want to live in their own home for as long as they can.
My original idea for a universal care entitlement accompanied by a care supplement would take the burden of social care funding away from local authorities, which is good, and, more importantly, offer certainty and security for the increasing numbers who will need social care in old age. No one would have to sell their house and see their inheritance disappear, everyone would have the chance of receiving better care and fewer people would be left unnecessarily in hospital beds as they wait for social care to be available. I am conscious that none of this is easy and that it will take political courage and possibly political consensus to achieve, but it is absolutely necessary if we are to provide peace of mind and security to frail, elderly people who richly deserve it. I commend these ideas to the Minister.
Helen Morgan (North Shropshire) (LD)
It is lovely to see you back in the Chair, Madam Deputy Speaker. I thank the hon. Member for Sheffield South East (Mr Betts) and the right hon. Member for Ashford (Damian Green) for their excellent speeches. I draw the House’s attention to the fact that I am a vice-president of the Local Government Association.
When the Government announced their local government funding settlement for the upcoming year and the additional £2.3 billion in grant funding at the autumn statement designated for social care, I welcomed that additional funding, despite concerns that much of the rest of the money will come from increased council tax. We are passing the buck from Government to local councils and, ultimately, as the hon. Member for Sheffield South East outlined eloquently, to local taxpayers who may not immediately see the benefit of the tax they are paying.
That funding will plug in the short term the gap in budgets caused by inflationary pressure, but we need to be mindful that 542,000 people are already waiting for care package assessments or direct payments and there are thousands of vacancies in England, according to the Association of Directors of Adult Social Services. The County Councils Network warns that councils and care providers are facing a perfect storm, as I am sure we are all aware, of rising demand, fewer care home beds, chronic staff shortages and acute inflationary pressures.
Shropshire is certainly no exception to that scenario. My meetings with local care providers have consistently shown that the sector is becoming fundamentally unstable, with some providers left facing a choice between losing money, or handing their contracts back to the council and restricting themselves to private work. We should acknowledge that social care is becoming a two-tier sector, where people who can afford a large amount of care in their home every day receive a very good service from skilled and caring workers who come and attend them, but those who are left with only a short visit in their own home see a much worse situation. I have seen that first-hand on an ambulance shift. It is heartbreaking to see people whose carers have popped in on a rushed schedule. They clearly care and have written everything down in the book—in one case, they had called the ambulance—but they do not have time to ensure that those individuals are living in the dignity they deserve. We need to ensure that that variation and those dual standards are addressed in the solutions we propose.
We have also seen that a shortage of care options is a factor in the acute emergency department and ambulance response crisis that Shropshire has faced, because people who are unable to be discharged home are restricting the patient flow through hospitals and ultimately stopping people coming in through the front door.
Today, I would like to raise in particular the challenges faced in the long-term learning disability and autism sector. In this sector, where people with learning disabilities need long-term care, the providers often do not have private clients from whom they can cross-subsidise their council-funded packages. My attention was drawn to that just before Christmas when I was alerted to the fact that three individuals in my consistency, who have lived in a care home together and been cared for by the same care home manager for more than 20 years, faced being split up and rehomed just three weeks before Christmas. Worse than that, because their levels of need were high and the care in North Shropshire met this need, they had come from across the United Kingdom and were funded by different councils. If their care home closes because of cost pressure, they will most likely be split from each other. As I am sure we can all imagine, the impact on those individuals would be extremely severe. I was grateful in this case that their provider was able to reassess their situation and keep them together in the same location, but the funding in this sector is so precarious that there is no guarantee that will be maintained.
As I understand it, the fair cost of care exercise excluded many social care services for people with learning disabilities, autism or severe mental health problems. In learning disability and autism services, a recent survey showed that 71% of providers have handed back a contract, declined to deliver a service or considered doing so in the past 12 months. Some 83% are subsidising services as charitable organisations that should be paid for in full by the state. We can all recognise that is fundamentally unsustainable, and I urge the Minister to consider some of the excellent suggestions from colleagues to stabilise this growing sector caring for our most vulnerable people.
Part of the cause of the instability across the whole sector is the fact that rising minimum wage levels have not been matched by funding from central Government to local councils, and therefore from those councils on to the providers. The national living wage increased by 6.6% from 1 April 2022, and it will go up by a further 9.7% from 1 April 2023. Clearly, that is necessary to deal with the cost of living crisis, and I am not here to begrudge care workers that increase. The staff in the sector are providing caring, highly skilled support, and they deserve to be recognised with a fair pay packet for the work they do.
In rural parts of Britain, such as North Shropshire, home care and community-based services are also seeing pressure from high fuel costs, and the council funding they receive does not take into account either the additional fuel they use travelling around such a large area, or the additional dead time there is between visits to people in rural places. In October 2022, Shropshire Partners in Care, an organisation of care providers in Shropshire, conducted a survey of its members, in which only 18% of respondents said that they felt the fees provided by the council covered their costs on a weekly basis. More than half confirmed that they have reduced the number of council-funded packages or places they are willing to accept.
When I meet care providers in my constituency and carers at work when I am on the doorstep, I am struck by their passion for providing high-quality care for their clients, but I have also been struck by the distress that the cost and recruitment pressures are placing on providers, because they are affecting the quality of service they deliver. The problem is nationwide, too. A Liberal Democrat councillor and friend in Cambridgeshire told me they are seeing an urgent crisis in adult social care there, too. They are facing an estimated 40% projected rise in funding for the elderly, but they have not got the Government funding to match, so they are looking at a £23 million funding gap going forward. They have nursing homes with 50% vacancy rates at peak points during the winter.
I urge the Minister to commit to looking at the long-term settlement for councils, because these costs, as colleagues have already described in great detail, will only increase. We need to ensure that we are fully funding the cost increases for care providers, so that people can receive the care they need and deserve, whether in a care home or, ideally, in their own home. The settlement also needs to take rurality into account and reflect the additional costs incurred when carers are travelling such long distances between homes. It is critical that councils have the flexibility to spend the funding they have been allocated in the most appropriate way for their own area and the requirements of their local demographic.
The Minister will be aware that the Liberal Democrats have called for a fully funded carers minimum wage set at least £2 above the national average, and paid for by a tax on online gambling platforms, to address the recruitment and retention challenges that are knocking into other areas of social and NHS care. Our increased wage would be centrally funded and it would ease the pressures on councils to find savings from elsewhere to meet their social care needs. The Care Quality Commission’s 2022 state of care report stated that
“our health and care system is in gridlock and this is clearly having a huge negative impact on people’s experiences of care.”
It went on to say:
“At the heart of these problems are staff shortages and struggles to recruit and retain staff right across health and care.”
I urge the Minister to consider the points that we have raised, to consider the crucial nature of ensuring that care workers are paid fairly so that they can be recruited and retained, and to consider that whatever the plan is going forwards, it needs to ensure that councils have certainty about their future funding. I urge him to take note of the pressures and to work with his Treasury colleagues to address some of the huge challenges that we have outlined today.
Selaine Saxby (North Devon) (Con)
It is a pleasure to see you back in the Chair on International Women’s Day, Madam Deputy Speaker. It is also a pleasure to follow the hon. Member for North Shropshire (Helen Morgan), whose constituency reflects mine in many ways. I will bring some colour from a constituency perspective to many of the issues and challenges that she highlighted around providing social care.
Devon is a prism of the future, because it has an elderly population that is only getting older. If anyone wants to see what the rest of the country will look like in 20 or 30 years, they should come to Devon. Similarly, if any of the great ideas coming out of this debate can be trialled or tested, I recommend Devon to the Minister as a great place to come. We are already on the journey of our county council frantically trying to balance its budget. Some 25% of the budget is spent on adult social care, and that amount has increased by 23%, adjusting for inflation, in the last decade alone.
As the hon. Member for North Shropshire mentioned, rurality is a huge factor. North Devon is remote, rural and coastal, so the distances involved in providing adult social care are monumental. The dramatic rise in energy costs has had a huge impact on social care providers’ ability to deliver the same service, and the increase in the council’s budget, unfortunately, does not fully reflect that.
Rurality also has an impact on the manner in which care is delivered in those communities, because of the distance that individual teams have to travel between daily stop-offs. That is overlaid with the pressures being placed on the hospital, which mean that some carers are having to make multiple visits a day—perhaps three—to one family, where they might previously have made one or two. That is escalating into a snowball effect of costs rising far higher than is reflected by the council.
I am now being contacted by providers of social care who are concerned about what is happening and their ability to continue to provide the care. One innovative care provider pays its care workers on a shift basis to reflect the distances travelled and the amount of time that care workers are not working, as opposed to paying them on a contact time payment methodology. Given the likely decrease in the next budget, however, it is unlikely to be able to continue that, even though offering that great package is how it has been able to train up and retain its fabulous staff team. If someone has to drive between appointments, why should they not be paid for the driving time, if it is the only way to get there?
We need to redesign the scheme for remote rural locations. As the Minister knows from his previous roles, we have a particular housing pressure in North Devon, so a different way of looking at it would be to remunerate a social care worker with accommodation as part of their package. That would enable them to serve that remote rural community without having to spend hours in the car driving between remote rural communities. The Department for Levelling Up, Housing and Communities might not be the right Department to suggest that to, but we cannot keep on pretending that the system is working. We need to find other ways and different solutions, particularly when rurality is being overlaid on the other pressures. At the moment, clients are being transferred away from better-qualified, better-quality care providers because the council budgets will not stretch, which is not right for the individuals involved. It feels fundamentally wrong that that is happening on my doorstep.
In North Devon, we are home to a fabulous hospital, which is the smallest and most rural in mainland Britain. It is not right that there is regularly a queue of ambulances outside it because we cannot discharge out of the back end due to a lack of social care. I have social care providers telling me that they have capacity but the council will not pay their rates to provide it.
As part of this process, I hope that somebody will look at the fair cost of care exercise in Devon, because there is some concern that the data that has been submitted is perhaps not being accepted as the true price of delivering that care. We need to acknowledge the prices involved, because these are humans who we need to look after and care for in our communities. There is also a concern that the cost pressures faced by the council are driving growth in the number of unregulated personal assistants and private carers.
Mr Betts
The hon. Lady is talking about the fair cost of care. I declare an interest as a vice-president of the Local Government Association, where there is a real concern that the money that the Government made available was not based on the detailed assessment that councils had done about the difference between what people pay for their care privately and what councils are paying. If councils suddenly ended up with that extra cost, the Local Government Association’s view is that the amount would be much more than the amount that the Government were putting to one side in their initial reform proposals.
Selaine Saxby
I thank the hon. Gentleman for his intervention; much more work needs to be done in this space.
We need to look for longer-term funding solutions. That is true for social care, but also for potholes, which I will mention while I have the opportunity, as my right hon. Friend the Member for Ashford (Damian Green) did. Part of the reason why some funding settlements do not add up is that when we provide a short-term funding solution, we cannot plan for the long term. I estimate that we are paying twice as much per pothole repair as a result of short-term settlements that stop councils from being able to plan effectively for their workforce, the work and the use of materials. I hope that there will be an opportunity to address some of those problems, because the pressure on budgets is having an impact on all council services, not to mention the individuals and the fantastic care staff involved.
Barbara Keeley (Worsley and Eccles South) (Lab)
I was not going to speak, but I have been drawn by some of the speeches that I have heard to add some comments, particularly on autistic people and people with learning disabilities and their care. One of the worst aspects of the chronic underfunding of adult social care is that it has led to a reliance on inappropriate in-patient care for autistic people and people with learning disabilities, 2,000 of whom are in that situation. The Government seem chronically unable to get that number down; there have been all kinds of targets to reduce it, but it has not happened.
That care is often expensive and far from home. The hon. Member for North Shropshire (Helen Morgan) told us about people in a care home far from their homes, but when the care is in in-patient units, it is often unsuitable. We know from scandals at units such as the Edenfield Centre, most recently, and Winterbourne View—there have been 10 years of scandals in those in-patient units—that they are frequently found to use restraint and seclusion as a punishment.
There have been inquiries and reports into the level of social care funding, such as that chaired by my hon. Friend the Member for Sheffield South East (Mr Betts), who made an excellent speech. The Health and Social Care Committee, of which I was a member, also looked into the issue and made recommendations. The squeeze on local authority funding means that local authorities feel that they have to put the bill on to the NHS—it becomes easier for a local authority to let the NHS pick up the bill for an autistic person or a person with learning disabilities.
Those placements can cost hundreds of thousands of pounds a year—up to £1 million. In one case that we have spent a lot of time talking about in the House, the NHS was funding a placement that cost £1 million a year. Clearly that makes no sense, because the money could go into housing or care for that person, but there does not seem to be any way to passport the money from the NHS, which is shelling it out every year, to the local authorities that would need it if they were to house and provide care for those people.
However, we had a solution years ago. When people were moved from long-term mental health institutions into the community, a dowry went with them from the NHS to the local authority. When I was the vice-chair of social services as a councillor, if we picked up somebody who had been in a long-term mental health institution to move them to the local authority, they came with a dowry that might be as much as £1 million. If a local authority were to buy a property or pay for care for a number of years, that system would work.
I urge the Minister to look at the recommendations made by the Health and Social Care Committee when we looked at this, but also to take account of what the hon. Member for North Shropshire said about how we cannot leave this in an unsatisfactory and precarious situation. It is good that some solution was found in the case she mentioned, but too often people end up in in-patient care and then will be there for the rest of their lives. There are people in these institutions who have been there 10, 20, 25 or 30 years, and it is tragic, because once someone has spent that long in an institution, it is very difficult to find a way back to the community. I wanted to mention that because it has been raised in the debate.
I want to mention one other thing. The right hon. Member for Ashford (Damian Green) and the hon. Member for North Devon (Selaine Saxby) talked about support and recognition for carers, and they are right to do so. We should all think about how we support unpaid carers. However, I want to say that I think the thing that is missing is that we do not have a proper national carers strategy. The last national carers strategy we had in this country was under the last Labour Government, and it came out in 2008. That would solve the problem, which my hon. Friend the Member for Sheffield South East talked about, of there being no respite care breaks for carers. That national carers strategy had a commitment of £255 million specifically to support carers, including £150 million for respite care breaks. We now find that there is no money we can identify or point to that is specifically for respite care breaks. Given the squeeze on local authority funding, it just does not happen.
What this Government have had is a carers action plan, which is a weak document. The last one, which covered 2018 to 2020, had no funding commitments and was very short of ambition. I know that carers organisations very much campaign for us to go back to having a national carers strategy, which in the case of the Labour Government had the commitment of the Prime Minister and each of the Secretaries of State responsible for services used by carers. I think the key thing, as we have heard in this debate—I really stress this point—is that we have to go back to having some money that is kept separately for respite care breaks for carers, otherwise they will be pushed and pushed, and they will not get the support they need.
I just wanted to speak on those two points, Madam Deputy Speaker, and I join everyone else in saying what a pleasure it is to see you back in your place.
Madam Deputy Speaker (Dame Eleanor Laing)
Thank you. I call the shadow Minister.
Sarah Owen (Luton North) (Lab)
Thank you, Madam Deputy Speaker, and may I also welcome you back? It is great to see you in the Chair.
Today we have been allotted time to speak about something the Government seem to do anything possible to avoid, and that is social care. It got barely a look-in in the autumn statement, and there is not much hope for next week’s Budget either. Every generation in this country is being failed by irresponsible, careless Conservative leadership—or, rather, a lack of leadership. Young people are having opportunities snatched from them by this Government. Working people are underpaid and cannot afford to buy their own home or pay the rent. Our older generation, who have toiled for decades, paid their taxes and contributed to our economy, are now being left in the lurch by the state when they need it the most. These are people such as the wonderful WASPI women whom I met outside Parliament today—women such as Josie from Great Yarmouth, Yvonne and Jane, who all told me to tell younger generations of women, “Look after yourself and plan for later life, because the likes of this Government won’t be there when you need them most.”
Our ageing population do not just deserve good social care; they should be entitled to it. It is their right, and in a country with the sixth largest GDP in the world, it is frankly mortifying that they are not afforded it. The social care sector is a problem the Tory Government have not just neglected, but actually made worse in their 13 years of power. There are currently record high levels of staff vacancies in adult social care—a staggering 165,000 vacancies. The existing workforce are burnt out, underpaid and overworked trying to cover the staff shortages. When I worked as a care worker, going into people’s homes to provide some of the most sensitive of support in sometimes less than 20 minutes, I knew the system was broken. Being pressured by managers to prioritise private patients over those who had support from the state, regardless of their need, was the wrong way of doing things then and it is the wrong way of doing things now.
It is worth noting that this debate is taking place on International Women’s Day. Later, we will hear a debate on childcare funding. While it might be a coincidence that these two debates are being held on this day, it is extremely meaningful. Some 80% of the care workforce are female, and that accounts just for the official staff. Under this Conservative Government, 2.3 million more people have given up some or all of their working hours to care for family members, because they cannot access professional support. That point was made eloquently by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley). The majority of those unpaid carers will be women, once again taking a hit to their careers, their finances and often their own health to provide care when the state has simply stepped back.
It does not have to be this way. As many as one in three hospital beds are currently occupied by patients who are ready for discharge, but who have nowhere to go. I am sure the Minister and his colleagues know as well as we do that these are not hospital beds going spare. Then there are the waiting lists. Many of us here will have a parent, a grandparent or a loved one in need of adult social care, or care for a younger person with disabilities. I wonder how many of us could say they have received the care they needed in a timeframe they are satisfied with.
Recent figures show a shameful trend of delays and let-downs in the social care sector. More than half a million people are waiting for an assessment, a review, the start of a service or a direct payment—half a million people. When will this backlog be dealt with and what are those people having to do in the meantime? I can take a guess at what some of them are having to do. As much as local councils, charities and places of worship try to plug the gaps left by this Government with food banks and warm banks, many pensioners are left shivering in homes, avoiding too much usage of their lights or televisions even, and watching their bills escalate. They are going to the shops to find no eggs and no tomatoes, and still coming back out of pocket. They are doing all this while dealing with their untreated health issues, and they are waiting up to 24 hours for ambulances to arrive in desperate situations.
Those people are wondering when exactly it was that this Government turned their back on them. Perhaps it was in 2022, when the Chancellor made it clear that social care was not a priority, allocating just £2.6 billion in new funds. Maybe it was in 2019, when a Tory party actually quite different from this one—we have gone through quite a few different leaders and Prime Ministers—promised that
“nobody needing care should be forced to sell their home to pay for it”,
while, on their watch, 28,000 people have exhausted their life savings to pay for care. That point was made by the right hon. Member for Ashford (Damian Green). But no, I think the betrayal of our older generation goes much further back than that.
In 2012, the current Chancellor was Health Secretary. He promised a cap on care costs, acknowledging the financial weight crippling individuals and families. The cap was legislated for in 2014, delayed until 2020 and then postponed indefinitely. After 10 years of being strung along, the hundreds of thousands of people needing adult social care were told in the autumn statement that any reforms of social care charges would have to wait until at least 2025. This is a heartbreaking and intensely frustrating situation for people waiting for answers and for security for the future. People are dying while waiting for state social care—150,000 over the last five years to be exact. I repeat: 150,000 people have died waiting for the care they never received. Will the Minister tell us how our constituents can really trust the Government to solve this crisis?
When he was Chair of the Health and Social Care Committee, the Chancellor stated that an annual sum of £7 billion was needed to plug the gaps in social care. One year later, and now in the position of power to allocate the very funding that he demanded for the sector, he pledged £7.5 billion over two years and, as we have established, only a quarter of that is new funding.
As the deliverers of state social care, local government leaders are well placed to judge what is needed. The Local Government Association has calculated that £13 billion is required to address the severity of the pressures facing the social care service. It states:
“An investment of this scale is needed to support our national infrastructure, our economy and our prosperity.”
Does the Minister believe that the Tory-led LGA is wrong about that? The LGA has also been critical of the Government’s model that continues to rely on council tax revenue to pay for social care. Council tax brings in vastly different amounts in different areas, depending on the demographic of residents.
In some areas, particularly rural communities, funds coming in from council tax are heavily outweighed by the demand for social care. As the hon. Member for North Devon (Selaine Saxby) eloquently put it, there are many different barriers to accessing social care—and good care—within rural communities, and that is just one of them. The hon. Member for West Dorset (Chris Loder) also made it clear that that is an issue. In a debate in January, he argued against the funding model, with one third of his constituents aged over 65, compared with a national average of 19%, which presents a huge need for care. He stated that Dorset Council’s spending on adult social care had risen by 15%, but that that was not touching the surface of the problem, and 83% of the council’s income was reliant on council tax.
The problem lies with central Government and the lack of a sustainable funding model. Fortunately, one party has a plan for social care, and we will not be postponing it for years or decades when we are in power. A Labour Government will implement a 10-year plan for investment and reform in social care. We will increase access and prioritise prevention and early intervention with home care. We will present a new deal for care workers that delivers fair pay, training and working conditions to recruit staff and—most importantly—retain them. We will ensure that unpaid family carers are no longer overlooked or taken for granted. If the Minister can present anything to rival that, I would genuinely love to hear it. As a former care worker, and someone whose grandparents have wonderful carers, I would love to say that we could put politics aside and come to a solution for the good of our country, but I also question the likelihood of that, given the 13 years of failure that we have seen from this Government.
I have mentioned some shocking figures, but I want to make it clear that social care is not about numbers—it is about people. It is about people in desperate need of care, who are often towards the end of life. It is about young disabled people, and families when they are at their most vulnerable. It is about the people providing that care through long hours, hard graft and low pay. Our nation’s older generation depends on them, and so will we when our time comes. I hope for everyone’s sake that they will still be there, and that this Government will not be.
The Parliamentary Under-Secretary of State for Levelling Up, Housing and Communities (Lee Rowley)
I add my voice to all those who have welcomed you back to the Chair in recent days, Madam Deputy Speaker.
I thank right hon. and hon. Members who have spoken in this debate. It has been a good debate that has highlighted some of the challenges, and demonstrated some of the opportunities in this area. I am particularly grateful to my near neighbour and Chair of the Levelling Up, Housing and Communities Committee, the hon. Member for Sheffield South East (Mr Betts). We do not agree on everything, but he had a long and illustrious history in local government before he joined this place, and since then he has taken a significant interest in this subject. I am grateful to him for introducing the debate in such an even-handed manner.
As all those who have spoken today have indicated, this is an important area of policy for a variety of reasons. That is why there is such close working between the Department for Levelling Up, Housing and Communities and the Department of Health and Social Care, given the importance of the issue, the need to get it right, and the need to continue to make progress on some of the challenges that have been highlighted. We have also worked closely to ensure some of the achievements that have come forward in recent years. As hon. Members will know, policy is largely within the Department of Health and Social Care and the funding process, via the local government finance settlement, is within the Department for Levelling Up, Housing and Communities.
I will try to answer the questions as best I can on all the elements that have been raised today. Colleagues raised a substantial number of points that fall into three broad buckets: first, where we are; secondly, where we are going; and thirdly, what we do about the long term. I will take those three points in turn.
First, there is no disagreement across the House that there are challenges, and that there have been difficulties on both a macro level and across government and society as a whole. There are also challenges within adult social care. More broadly, over the past 20 years, under Governments of all parties, we have seen changing demographics. It is great that more people are living longer, but that creates challenges for whoever is on the Treasury Bench to ensure that the Government support people to the extent that they can. There is often greater acuity with individuals in the system, and more have multiple conditions. More broadly, in recent years and despite valiant attempts by the hon. Member for Luton North (Sarah Owen) to gloss over them, we have received the challenges of inflation, of external events and of covid, all of which have created issues across the Government. A mature debate will recognise and acknowledge those challenges, and seek to build on them and resolve them over time.
The hon. Member for Sheffield South East is correct to say that funding has been much questioned over the past 13 years, and we will all have different views on that. The issue has been much discussed since 2010, just as the reasons behind decisions that were taken between 2010 and now have been much discussed. I will not detain the House by repeating those reasons, other than to say that we know them, and that they are at least anchored in a set of decisions that were taken before 2010. It is also important to acknowledge—I hope hon. Members will do this—that significant additional funding has gone in and is going in over the remainder of the spending review period, with £2 billion of additional grants in 2023-24, and nearly £1.5 billion of additional funding in 2024-25. Money is not everything, but ultimately there is a recognition in all parts of the House that there are challenges with adult social care, and more money has gone in.
The hon. Gentleman also talked about the way we fund. Although I accept challenges from right hon. and hon. Members about the right balance, I hope we can agree within our discourse that it is reasonable and proportionate for us to have both funding provided centrally and an element of local funding, not least so that there is linkage between how organisations and local councils decide to spend that money in the locality and how they raise it. As I say, I accept that there are different views about what the proportions should be, but I hope that future discussion of this issue acknowledges the reality and appropriateness of that balance.
Although I am trying not to be too political, it is important to note that some of the challenges have been in place over recent years because there has been a challenge with Government funding over the course of 13 years. We have been trying to keep taxes down for people when we are able to do so. It is important to note that council tax more than doubled under the last Labour Government, and we have spent a significant amount of time and effort in the local government system since 2010 making sure that increases are as low as they can be.
Barbara Keeley
The Minister is talking about the balance between funding being found locally and funding from central Government grant. The issue I have outlined is that it would be unreasonable for a local authority to have to find something like £1 million extra. I have talked about placements for people with learning disabilities or autistic people that can cost up to that. That cost is being borne by the NHS, yet it could be much lower if the person had suitable housing found for them in the community. It is not reasonable to expect a local authority suddenly to find a large amount of money if a case comes up. Together with colleagues from the Department of Health and Social Care, will the Minister look at the idea of a dowry that I put forward, so that people do not have to spend 10, 20 or 30 years in horrible NHS institutions that are often far from home and unsuitable? This is just a logistical problem about where the money is, and it seems that of all the problems we could solve, this is one we should be doing something about.
Lee Rowley
I am grateful to the hon. Lady for her intervention. I will come to her points in a moment.
I acknowledge the point that my hon. Friend the Member for North Devon (Selaine Saxby) made about rurality, which is one reason why it is important that there is a balanced understanding that some funding is raised locally. Different parts of the country will have different requirements, pressures and challenges, which, in many parts of the country, will include rurality. I accept that that creates an issue in certain places. From a local government perspective, rather than an adult social care perspective, we have tried to acknowledge that, at least in part, in the local government finance settlement through the rural services delivery grant. I am always happy to look at that and to talk to my colleagues in more detail, as we prepare for funding settlements in future years.
Selaine Saxby
Does my hon. Friend acknowledge that in massive counties such as Devon, outside the urban south, the very rural hinterland causes variance from the average, and that top-tier authorities should have much more leverage to offer settlements with a far greater differential between rural and urban areas?
Lee Rowley
I certainly acknowledge that there are differences in individual circumstances between rural areas, urban areas, and suburban and near-rural areas, one of which I have the privilege to represent in Derbyshire. The finance settlement seeks to acknowledge that to some extent. As I will come to in a moment, we are also introducing Oflog—the office for local government—which will seek to understand how councils spend the money they receive or raise, so that we can understand the differences that occur around the country and also how people choose to make decisions arising from those differences.
Let me come to the second point, which is where we are going.
Lee Rowley
If I may make a little more progress, I will happily give way to the hon. Gentleman.
I recognise the points that have been made about reform. I note that the hon. Gentleman, my right hon. Friend the Member for Ashford (Damian Green) and others highlighted the importance of looking at how we can continue to improve adult social care in the round and over time, and I pay tribute to my right hon. Friend for his work in the all-party parliamentary group on adult social care in that regard. I also note the broader questions of what we do over the long term, over many years and decades, and some of the issues that the hon. Member for Worsley and Eccles South (Barbara Keeley) highlighted, and also the intervention from my right hon. Friend the Member for East Yorkshire (Sir Greg Knight) about the importance of carers, which I absolutely acknowledge. I will certainly pass back to my colleagues in the Department of Health and Social Care all the policy points, which absolutely have been heard today.
Both my right hon. Friend the Member for Ashford and the hon. Member for Sheffield South East highlighted alternatives, and mentioned Japan and supplements. Decisions about how best to fund the system are long-standing and challenging, and there are always alternatives; I hope it will be recognised that the Government have tried to resolve some of the issues through changes and proposed reforms over the last couple of years, even if they are later than originally intended. There is acute difficulty and challenge in reforming this area, and successive Governments of different colours have been unable to do what many people would like to happen, yet we are determined as a Government to get it right. I hope we have demonstrated progress—both in the short term through further amounts of funding, and through the reforms we proposed a couple of years ago—and we will continue to try to do that.
Mr Betts
I thank the Minister for giving way; his further comments were quite helpful because they lead on to the intervention I was going to make, which comes back to local funding for social care. The joint report by the two Select Committees in 2018 said:
“There should be a continuation for the foreseeable future of the existing local government revenue streams.”
That was accepted, but we went on to say, very clearly, that a new source of funding is needed for social care to recognise the gaps that exist. Does the Minister accept in principle that the Government must come up with a new, discrete source of funding for social care? The Government sort of got there two years ago, then backed off. Are they going to come back to that at some point?
Lee Rowley
As I think the hon. Gentleman is aware, substantial additional funding has gone into the system. I am always happy to discuss the best way that that should be structured—obviously that is a multi-departmental discussion—but I hope there is an acknowledgement that additional funding has gone into the system and continues to go in. The additional information given in our announcements about the remainder of the spending review, over the coming financial year and the year after, demonstrates our commitment to do that. We hope that will have a positive impact on the challenges that have been articulated.
Finally, I want to talk about the long term, which hon. Members from across the House raised in their speeches. We acknowledge that there is a desire, and it is important to try to plan for the long term. We will bring forward a plan for adult social care reform in the spring. I hope that will answer some of the questions that hon. and right hon. Members have raised and assuage some of their concerns locally. To answer the challenge from the hon. Member for North Shropshire (Helen Morgan) about a long-term settlement for councils, while some of the long-term nature of that is debatable, I hope that the broader policy statement, which the Government announced several weeks ago with the local government finance settlement, demonstrates our intent to move forward with a longer-term understanding of what councils can expect to receive from Government, where we are able to do that. As I have highlighted, in the long term we are also seeking to introduce new elements to government, such as the office for local government, which hopefully will provide information not just about what is happening, but information that explains in more detail how local government is spending that money.
Lee Rowley
I have detained the House, but I will be happy to give way briefly.
Helen Morgan
I am grateful to the Minister. The point about long-term funding is so important. Until a couple of weeks ago, care providers in Shropshire did not know by how much their rates would increase in the new financial year, and they were considering handing their contracts back. It would have cost the council a fortune just to find someone who was willing to fulfil some of those care packages. Councils need long-term funding for their own financial stability and to find care packages at an achievable cost.
Lee Rowley
I am happy to confirm that the Government are trying, where we are able, to offer greater visibility of what is coming and greater long-term understanding. We will continue to try to do that across the local government finance settlement, and I hope this policy statement is an indication of that.
Sarah Owen
I appreciate the Minister’s generosity in giving way, and I completely agree on the kind of long-term futures that we talking about for local government, yet we are 23 days away from local authorities setting their budgets and they have still had no indication about their public health grants. If we are going to treat local authorities with respect on healthcare, surely they should be given that well in advance.
Lee Rowley
I know that my colleagues across Government will be working hard to get the final elements of the settlement out as soon as possible, but I hope the hon. Lady will acknowledge that, on the basis of my conversations with local government over the past few weeks, there is a recognition that the settlement has provided a good level of funds, that it will be moving in a positive direction and that it provides the stability and greater certainty that local government has requested and that we have responded to as a Government.
To conclude, I again thank the hon. Member for Sheffield South East for instigating and opening this debate. I also thank everybody outside this place who supports adult social care. It is an extraordinarily important part of local government and the state’s activities in general. As has been outlined in this debate, we need to support the most vulnerable and those in need, irrespective of age or condition. Through the changes that are coming in the new financial year, we are trying to provide additional funds, support and taxpayer subsidy to do that, and to ensure that local government can continue to build and improve for the long term in such an important policy area.
Mr Betts
Madam Deputy Speaker, you came into the Chair as I was halfway through, so let me, too, welcome you back.
This has been a good debate. Whether it has taken us forward, only time will tell. The challenges are there and hon. Members, certainly the co-chair of the all-party group on adult social care, the right hon. Member for Ashford (Damian Green), expressed it. We spoke in very similar terms on very similar issues. The concerns are there. As was said in the debate, it is about individuals: individuals getting care that is often not to the standard they need; individuals not getting care at all because the eligibility criteria have changed; people sitting in hospital beds for days on end because the care is not available to them. In the end, this is a very human issue we are dealing with. We are dealing with a workforce under enormous strain and pressure, not properly paid and sometimes not properly trained, with far too much expected of them. Councils are struggling to do their best to represent their local community. Councils across the board of all political persuasions are having to make impossible choices to deal with social care and the people who need it, as against having to sweep the streets and run bus services that are vital to their communities. This is an issue that needs to be addressed.
I come back to what I said in my last intervention on the Minister. We cannot carry on believing that the existing local government finance system, with occasional top-ups from Government on an ad hoc basis every year or so, will sustain adult social care for the longer term or even the medium term. We must reach some sort of agreement on a way forward that brings an additional funding stream into local government to take the strain off the rest of local government finances, put social care on a proper footing, increase the eligibility criteria, get a long-term plan for the workforce, and ensure, ultimately, that the people who need social care get it and get it to a proper and decent standard.
Question deferred (Standing Order No. 54).
Department for Education