Social Care

Baroness Keeley Excerpts

Wednesday 16th November 2016 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I beg to move,

That this House notes the serious concerns expressed about the social care system, including by the Local Government Association, The Association of Directors of Adult Social Services and the Care Quality Commission; calls on the Government to urgently bring forward promised funding to address the current funding crisis and to put in place a longer-term settlement to ensure that the social care system is sustainable going forward; and further calls on the Government to ensure that the most vulnerable in society are guaranteed the adequate and sustainable care they deserve.

The Government amendment

“commends the work and dedication of those in the social care sector”.

I join the Government in that. It might be the only part of their amendment I support. It is right that we praise our care staff. Unison the union had a meeting here today with care staff from a London borough and from Leicestershire. They talked about the difficult financial situation facing care services. Some care providers are not paying a decent wage. I heard all about that from the care staff from the London borough. Care staff receive less than the national minimum wage. They are not paid for travel time and they are not paid the correct rate if they sleep over. We should value our care staff more highly, we should pay them properly, we should train them, and they should know that they do a valued job. I pay tribute to the care staff I met today. I hope that other hon. Members also attended that event and met the same care staff and that they read Unison’s report, which is called “Care in Crisis”.

Social care is “in crisis” owing to a lack of funding. So says the Conservative leader of the Local Government Association’s community wellbeing board, Councillor Izzi Seccombe, who says that

“it is no exaggeration to say that our care and support system is in crisis.”

Richard Humphries, of the King’s Fund, talks of

“a deeper existential crisis of care”.

The Care Quality Commission says that the sustainability of social care is seen as “approaching tipping point”. Ray James, of the Association of Directors of Adult Social Services, says that

“the Government must face up to the reality that social care is in crisis now and provide immediate funding to stabilise the sector.”

On the priority of providing extra funding for social care, NHS England chief executive, Simon Stevens, says that

“there is a strong argument that were extra funding to be available…we should be arguing that it should be going to social care.”

I could go on. Googling the words “social care funding crisis” returns 2 million results.

[Alex Cunningham (Stockton North) (Lab)]

It is stating the obvious to say there is insufficient money going into the system, yet we have private companies taking huge profits out of the system as well. Will my hon. Friend join me in commending Stockton-on-Tees Borough Council for setting up a not-for-profit organisation to ensure that the money goes into services instead of shareholders’ pockets?

[Barbara Keeley]

I certainly will join my hon. Friend in commending the council. It is one of the things we talked about to the care staff today. Why should people be paid vast profits from public money, when care staff are so badly paid?

The reasons for the social care funding crisis are clear: insufficient funding in the face of growing demand and a fragile market in the provision of social care. We know that people are living longer and that demand on social care services continues to increase. People aged 85 and over are the group most likely to need care, and their numbers are projected to rise sharply in the coming years. Moreover, the gap between need and funding has grown wider since 2010.

[Robert Flello (Stoke-on-Trent South) (Lab)]

The sustainability and transformation plan for Staffordshire, some of which has been leaked to me, NHS England and NHS Improvement having categorically refused to make it available to Members of Parliament, shows a deficit for Staffordshire over the coming years of more than £250 million. Is that not appalling?

[Barbara Keeley]

It is dreadful. The deficit in Greater Manchester is £1.75 billion, so the problem is the same up and down the country.

We have had six years of Government cuts to local authority budgets, and that has seen local authority spending on the care and support needs of older and disabled people fall by 11% in real terms. In fact, the number of people getting publicly funded support has plummeted: 400,000 fewer now than in 2009-10. Such facts are shocking, but behind the statistics are real issues: the impact that cuts to social care are having on the NHS, on people who need care and on unpaid family carers.

First, I will deal with the issues that the crisis in social care causes for the NHS. As the Nuffield Trust states:

“Hospitals have struggled to meet the needs of the older age group in a timely way, in both emergency departments and inpatient admissions”.

The most visible manifestation of the pressures caused by cuts to social care budgets is the rapid growth of delayed transfers of care from hospital. The September figure of over 196,000 delay days is another record—the highest figure for six years—and it comes not in winter but at the end of summer. That means for the NHS 6,700 patients stuck in hospital. The most common causes are waiting for a care home placement and waiting for a nursing home placement.

The funding that was supposed to help with these issues is the better care fund, but there is no extra funding for social care in the fund this year and only £100 million next year.

[Karin Smyth (Bristol South) (Lab)]

My hon. Friend is making an excellent speech. Does she agree that it would be useful to remind Conservative Members of the Conservative party manifesto? Page 65—I do not want anyone to struggle to find it—outlines the promise to the people concerned. It says that they would not have

“to sell their home to pay for care”,

and that there would be a cap on charges to give people “peace of mind” and protection. All that is in the Conservative party manifesto—“peace of mind” and protection “from unlimited costs”. It amounts to a cruel disservice to that generation that the Government went back on that promise just two months into this Session.

[Barbara Keeley]

It is, and I agree with my hon. Friend that care costs are just running away with themselves, making the situation much harder for people.

The bulk of the extra funding that the Government promised to social care from the better care fund comes in 2018-19 and 2019-20. We have had six years of cuts to local authority budgets, and the extra funding promised for social care is backloaded to those later years in this Parliament.

[Helen Whately (Faversham and Mid Kent) (Con)]

The hon. Lady mentioned the most common causes of delayed transfers of care. However, I know that in hospitals in Kent near my constituency, around 30% of the delayed transfers of care are attributable to delays in social care and the majority are for other reasons. Does she not agree that it is important for the NHS to take its own steps within its own organisations to improve people’s discharge from hospital?

[Barbara Keeley]

That is what we are debating. Of course the NHS should put its own house in order, too, but delays should not happen on account of social care. People should not be stuck for weeks or months in hospital, waiting for a care home placement or a nursing home placement. I shall go on to say why.

Returning to the issue of the backloading of funding, in view of what was happening to social care, the Local Government Association and the Association of Directors of Adult Social Services appealed before the last autumn statement for £700 million of the promised better care funding to be moved forward to this year and next year. That appeal was ignored. Reacting to that, Ray James of ADASS said:

“Ministers must know that their proposals do not deliver sufficient funding to meet the growing number of older and disabled people requiring increasingly complex care and support…The Council Tax precept will raise least money in areas of greatest need which risks heightening inequality. Councils in deprived areas will have greatest social care needs, yet they will raise less than a third of what more affluent areas do through this approach.”

He went on by clarifying that ADASS does

“not believe that the funding for the next couple of years will anywhere near meet the costs of the national living wage and the increasing demand for social care.”

[Diana Johnson (Kingston upon Hull North) (Lab)]

In my Hull constituency, not only have we seen massive cuts to the local government budget since 2010, but the precept that we can raise—2%—is much smaller than the gap in the budget for social care. By comparison, wealthier areas of Yorkshire such as East Riding are able to raise far more, so this is a double whammy for deprived areas.

--- Later in debate ---

[Barbara Keeley]

It is indeed. The gap in my Salford local authority area is £1.1 million. We can raise only £1.6 million from the social care precept, while just paying the national living wage in the care sector is costing us £2.7 million.

Let me return to the matter of where the promised funding sits. In our motion, we call on the Government once again

“to bring forward promised funding”

for 2019-20

“to address the current funding crisis”

in social care. I am sure that the Health Secretary hears plenty about the impacts on the NHS of the missing funding for social care, but let us also think about the impacts on the people who actually need that care.

The hon. Member for Faversham and Mid Kent (Helen Whately) mentioned the thousands of patients stuck in hospital. We should be aware that keeping them there longer than necessary can have a number of detrimental effects. Long stays can affect patient morale and patient mobility, and of course increase patients’ risk of catching hospital-acquired infections.

Effects on mobility can be particularly keenly felt by older patients. As Professor John Young said in the 2014 national audit of intermediary care:

“A wait of more than two days negates the additional benefit of intermediate care, and seven days is associated with a 10% decline in muscle strength.”

As my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier), the Chair of the Public Accounts Committee, observed when the Committee published its own report on discharging older people from hospitals:

“Delayed discharge is damaging the health of patients and that of the public purse.”

Cuts to the funding of social care also affect a larger group of older and vulnerable people, and those cuts are now having a major impact on family carers. Age UK estimates that more than a million older people in England are living with unmet social care needs. I was struck by what the Unison staff told me about the many people they see during their care visits who are lonely and isolated.

Social care services have clearly failed to keep pace with increasing demand. Carers UK tells us that the drop in social care support, in the context of the increasing needs of our ageing population, is having a profound impact on the unpaid family carers who are stepping in to provide more care than ever before. It also tells us that the increase in the number of people providing care, and the increased number of hours of care that they provide, are being delivered at a huge personal cost to those family carers if they are not well supported—as, in all too many cases, they are not.

[Maria Caulfield (Lewes) (Con)]

The hon. Lady is making a case for more funds for social care. May I ask how the Labour party would raise that money? Would it give more to local authorities, or would it increase council tax precepts further?

[Barbara Keeley]

Our motion asks for promised funding that is backloaded to 2019-20 to be moved forward. The LGA and ADASS wanted it to be moved last year, and that is what we keep asking for.

[Maria Caulfield]

I thank the hon. Lady for giving way again; she is being extremely generous. Will she tell me, however, whether she is committing her party to delivering that money to local authorities directly, or to allowing them to increase their precepts?

[Barbara Keeley]

We do not even know what the Chancellor is going to do next week. The hon. Lady has invited me to make a declaration today, and it was a nice try, but we did not hear a word from Ministers about their plans during Health questions yesterday. I will, however, make what I think is an important point to the hon. Lady and to any other Member who raises the same issue. Labour would not have put our councils in this position to start with. If the hon. Lady looks back at our spending plans, or looks at the analysis by the Institute for Fiscal Studies relating to the different parties, she will find that our plans meant that we did not have to make the cuts that her party has made. This Government’s cuts will take £5 billion out of social care. I will send her the link to the IFS analysis if she wants to read it.

[Toby Perkins (Chesterfield) (Lab)]

My hon. Friend is making a powerful case. The scale of the crisis in some areas is very serious, and it will become even worse following the increase in the minimum wage. Although that increase is welcome, if the local authorities do not have the budgets to cover it, the crisis will be exacerbated.

Is my hon. Friend aware that many providers in both the private and the charitable sectors are returning council contracts? They are saying, “We can no longer make this pay; in fact, we will go bankrupt if we carry on servicing the council.” That is adding to the current problems.

[Barbara Keeley]

My hon. Friend has made a key point. I have already mentioned the fragility of the care market. We shall not be able to explore that fully during my speech, but it is a serious factor. If we do not get the funding right, more and more care providers will simply walk away. At the Unison meeting, members of a Leicestershire rehabilitation team spoke of the problems that they experience when care providers walk away from a contract. When the staff are not there any more, they have to plug the gaps.

[Mr Clive Betts (Sheffield South East) (Lab)]

The Communities and Local Government Committee is conducting an inquiry into the funding of social care. We have learned that not only are care providers handing contracts back, but councils are terminating contracts because of the inadequacy of the care that is provided. Ultimately, that means that individuals do not receive the care that they should be receiving. Their appointments are cancelled, or there are flying visits from under-trained care workers who are paid less than the minimum wage.

[Barbara Keeley]

My hon. Friend is right, and I shall come to that point shortly.

Carers UK reports that insufficient support from health and social care services is leaving the carers who are doing all that extra work

“isolated, burnt-out and unable to look after their own health.”

The Richmond Group of Charities published the story of Susan. She cares for her husband Bruce, who has been diagnosed with both Parkinson’s and dementia. The struggle that Susan underwent to find quality care is one about which I have been hearing from carers for some time. She was provided with respite care from a care home which was of such low quality that her husband was unrecognisable when she returned for him:

“He hadn’t been shaved, he couldn’t walk, and his eyes were crusted…with blepharitis.”

When Susan managed to get home care for her husband, it was also poor quality. She said:

“They didn’t know what they were doing. It seemed like they’d never cared before. They turned up at five o’clock in the afternoon to put my husband to bed. Or they turned up at ten, once I’d already helped him to bed. Absolutely awful.”

It is also telling how carers like Susan feel when dealing with the challenges of negotiating complex and fragmented care systems. She “felt small” and she said:

“You go in there, and you’ve got no idea about anything, about care. It’s like going in on the first day at school.”

Susan is not a rare case of a carer battling to get respite care or home care of an acceptable quality. Carers UK tell us that three out of 10 carers in its survey have experienced a change in the amount of care and support services that they receive. Six out of 10 of those carers experiencing a change said the amount of care and support received had been reduced.

[Norman Lamb (North Norfolk) (LD)]

The hon. Lady argues for bringing forward funding, and I agree. Does she agree, however, that that is not enough in itself and that all of us on both sides of the House must confront the chronic underfunding of the health and care system, and we need to find ways to raise significantly more resources to ensure we have a modern and efficient health and care system?

[Barbara Keeley]

I agree, and our motion talks about the need for

“a longer-term settlement to ensure that the social care system is sustainable going forward”.

We absolutely do need that.

On quality of care, I was talking about Susan finding a care home and it giving inadequate care. There are too many such care homes. In its 2016 “State of Care” report, the Care Quality Commission said that when it makes a return visit to a service originally rated as “inadequate”, one quarter of those services were not able to improve their ratings. Susan found poor-quality home care, and last week the ombudsman reported that the number of complaints about homecare is rising and that the number of complaints upheld by the ombudsman is also rising.

[Dr Sarah Wollaston (Totnes) (Con)]

I agree with the right hon. Member for North Norfolk (Norman Lamb) on the need for cross-party working to achieve sustainable funding for both health and social care. As the hon. Lady will know, I have set out my concerns about the underfunding of social care in a letter to the Chancellor. Does she agree that it is not just about funding, however, but also about how we support and train our social care staff? Would she like to see further progress made on the recommendations of Camilla Cavendish about how we train and support our care staff to help to retain them as well as recruit them?

--- Later in debate ---

[Barbara Keeley]

I agree, and that is why I started my speech by saying we should value the job our care staff do and we should train them properly; it should be a proper job with a proper career path. The care staff I met today were reduced to worrying about what they were being paid, however, simply because they were paid less than the minimum wage.

This is what six years of funding cuts to social care actually mean for people who need care and their carers: unmet needs for care; patients stuck in hospital, increasingly because they have to wait for a care home or a nursing home place; poor care in care homes, with one quarter of “inadequate” services unable to improve; poor home care, with more complaints being upheld by the ombudsman; more unpaid family carers having to step in to care; more unpaid family carers having to provide increased levels of care; and, without the right support, those family carers becoming isolated, burnt-out and unable to look after their own health. That is a disturbing deterioration in the state of social care. I want the Secretary of State to tell us whether he recognises the scale and seriousness of the issues I have outlined.

[Mrs Madeleine Moon (Bridgend) (Lab)]

As chair of the all-party group on Parkinson’s—and motor neurone disease—I have had repeated complaints about the 15-minute calls that local authorities are being forced to introduce because of cuts in their social care allowance. They mean that people are neglected: carers literally run in, and, if the person cannot communicate or has poor mobility, the quality of their care is appalling.

[Barbara Keeley]

It is indeed. There are many examples of that, and we have debated them here many times. The funding crisis is at the base of all this.

I repeat what I said at the start of my speech: social care is in crisis due to a lack of funding. It is notable how many leading doctors, health experts and organisations involved with the NHS are now expressing their concerns and fears about social care and the lack of funding for it. Here are some of those people: Simon Stevens, chief executive of NHS England; Miss Clare Marx, president of the Royal College of Surgeons of England; Professor Dame Sue Bailey, chairwoman of the Academy of Medical Royal Colleges; Dr Suzy Lishman, president of the Royal College of Pathologists; Professor Carrie MacEwen, president of the Royal College of Ophthalmologists; Professor Neena Modi, president of the Royal College of Paediatrics and Child Health; Professor David Oliver, president of the British Geriatrics Society; Dr David Richmond, president of the Royal College of Obstetricians and Gynaecologists; Professor Sir Simon Wessely, president of the Royal College of Psychiatrists; Dr Anna Batchelor, dean of the Faculty of Intensive Care Medicine; Dr Liam Brennan, president of the Royal College of Anaesthetists; and Professor Jane Dacre, president of the Royal College of Physicians. All those people have expressed their fears and concerns about social care and the lack of funding for it.

I should like to add to that list some of the organisations working in the NHS and social care that are now expressing their serious concerns about the funding of social care. They include: the King’s Fund, the Nuffield Trust, the Health Foundation, the Local Government Association, the Association of Directors of Adult Social Services, the County Councils Network, the BMA, Care England, Unison, Age UK, the Alzheimer’s Society, the British Red Cross, Carers UK, Independent Age, United for all Ages, the Learning Disability Coalition, the Motor Neurone Disease Association, and the Care and Support Alliance. Those people and those organisations share a belief that the Government must act now on social care funding, and I urge hon. Members on both sides of the House to support our motion and vote to save social care tonight.