Health and Social Care
Baroness Keeley Excerpts(6 years, 6 months ago)
Ministerial CorrectionsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Barbara Keeley
The Secretary of State announced to the House in December 2016 that he would ask the review for annual reports on its findings, so why was a review of this importance published during the recess, before a bank holiday weekend in the middle of local election results, giving Members little chance to scrutinise its findings? When asked about the report on the “Today” programme on Radio 4, Connor Sparrowhawk’s mother, Dr Sara Ryan, said that she was
“absolutely disgusted by the report”
and that the way it had been published at the beginning of a bank holiday weekend
“shows the disrespect and disregard”
there is for the scandalous position of people with learning disabilities shown in the report.
Caroline Dinenage
On the date of publication, the hon. Lady will be aware that this was an independent report prepared by the University of Bristol and commissioned by NHS England, which wanted to look into this really important issue, and because it was an independent report, it did not actually alert us to publication, so we had no more notice than she did. We are investigating through NHS England and others why that happened. [Official Report, 8 May 2018, Vol. 640, c. 546.]
Letter of correction from Caroline Dinenage:
An error has been identified in the answer given to the hon. Member for Worsley and Eccles South (Barbara Keeley) on 8 May 2018.
The correct answer should have been:
Learning Disabilities Mortality Review
Baroness Keeley Excerpts(6 years, 6 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Barbara Keeley (Worsley and Eccles South) (Lab)
To ask the Secretary of State for Health and Social Care to make a statement on the learning disabilities mortality review. [Interruption.]
Mr Speaker
Order. There is a certain amount of chuntering from a sedentary position. The Secretary of State has been with us, but Minister Caroline Dinenage will answer the urgent question, and we look forward to her answer.
The Minister for Care (Caroline Dinenage)
The Government are absolutely committed to reducing the number of people with learning disabilities whose deaths may have been preventable and have pledged to do so with different health and care interventions. The learning disabilities mortality review programme was established in June 2015; it was commissioned by NHS England to support local areas in England to review the deaths of people with a learning disability. Its aims were to identify common themes and learning points, and to provide support to local areas in their development of action plans to take forward the lessons learned.
On 4 May, the University of Bristol published its first annual report of the LeDeR programme, covering the period from July 2016 to November 2017. The report included 1,311 deaths that were notified to the programme and set out nine recommendations based on the 103 reviews completed in this period. The Government welcome the report’s recommendations and support NHS England’s funding of the programme for a further year at £1.4 million. We are already taking steps to address the concerns raised, but the early lessons from the programme will continue to feed into our work, and that of our partners, to reduce premature mortality and improve the quality of services for people with learning disabilities.
Barbara Keeley
Mr Speaker, I think it is disgraceful that the Secretary of State has just run out of the Chamber, rather than answering this question himself—it is disgraceful.
Seven years after Winterbourne View and five years since the avoidable death of Connor Sparrowhawk, the findings of the review show a much worse picture than previous reports about the early deaths of people with learning disabilities. One in eight of the deaths reviewed showed that there had been abuse, neglect, delays in treatment or gaps in care. Women with a learning disability are dying 29 years younger than the general population, and men with a learning disability are dying 23 years younger. Some 28% of the deaths reviewed had occurred before the age of 50, compared with just 5% of the general population who had died by that age.
The Secretary of State announced to the House in December 2016 that he would ask the review for annual reports on its findings, so why was a review of this importance published during the recess, before a bank holiday weekend in the middle of local election results, giving Members little chance to scrutinise its findings? When asked about the report on the “Today” programme on Radio 4, Connor Sparrowhawk’s mother, Dr Sara Ryan, said that she was
“absolutely disgusted by the report”
and that the way it had been published at the beginning of a bank holiday weekend
“shows the disrespect and disregard”
there is for the scandalous position of people with learning disabilities shown in the report.
Only 103 of 1,300 cases passed for review between July 2016 and November 2017 have been reviewed. That is a paltry number. The report cites a lack of local capacity, inadequate training for people completing mortality reviews and staff not having enough time away from their duties to complete a review.
If there are issues around capacity and training, what is NHS England doing to rectify this? Sir Stephen Bubb, who wrote the review into abuse at Winterbourne View, said this in response to the report:
“there can be no community more abused and neglected than people with learning disabilities and their families. How many more deaths before we tackle this injustice?”
Dr Sara Ryan said:
“things have actually got worse than they were 10 years ago”.
What action will the Government take to show the families of people with learning disabilities that their relatives’ lives do count?
Caroline Dinenage
I thank the hon. Lady for raising this issue; the report makes for very troubling reading.
On the date of publication, the hon. Lady will be aware that this was an independent report prepared by the University of Bristol and commissioned by NHS England, which wanted to look into this really important issue, and because it was an independent report, it did not actually alert us to publication, so we had no more notice than she did. We are investigating through NHS England and others why that happened.[Official Report, 9 May 2018, Vol. 640, c. 8MC.]
As the report clearly identifies, there is still more work to do, and we will work with partners to see how the recommendations may be implemented. We are committed to learning from every avoidable death to ensure that such terrible tragedies are avoided in the future. She mentions Dr Sara Ryan, whose son, Connor Sparrowhawk, died in such tragic circumstances in my own Southern Health Trust area. She and other parents like her are testimony to the incredible dedication of people who have worked so hard to get justice for their loved ones at a time when they feel least able to do so.
We have done several things already. We have introduced a new legal requirement so that from June every NHS trust will have to publish data on avoidable deaths, including for people with a learning disability, and provide evidence of learning and improvements. We are the first healthcare system in the world to publish estimates of how many people have died as a result of problems in their care. Learning from the review is also informing the development of the pathways of care published by NHS England and the RightCare programme, which is tailored to the needs of people with learning disabilities. Pathways on epilepsy, sepsis and respiratory conditions will be published later this year.
We have introduced the learning disability annual health checks scheme to help ensure that undiagnosed health conditions can be identified early. The uptake of preventive care has been promoted and improved, while the establishing of trust between doctors and patients is providing better continuity of care. We have also supported workforce development by commissioning the development of learning disabilities core skills education and training framework, which sets out the essential skills and knowledge for all staff involved in learning disability care.
As I said, the report makes for troubling reading, but we asked NHS England to commission it so that we might learn from these deaths and make sure that trusts up and down the country are better equipped to prevent them from happening in the future.
Oral Answers to Questions
Baroness Keeley Excerpts(6 years, 6 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Hunt
My hon. Friend makes an important point: unless we make it easier for trusts to retain the receipts of property transactions, they will be likely to sit on these properties and we will not get the positive ideas such as that suggested earlier by the hon. Member for Ilford South (Mike Gapes), so we do need to find a way to make sure that local areas benefit when they do these deals.
Barbara Keeley (Worsley and Eccles South) (Lab)
The Alzheimer’s Society estimates that at least 10,000 people with dementia have been stuck in hospital in the last year despite being ready to leave, and many of the delays were caused by a lack of care in the community for them. There can be no more disorientating thing for a person with dementia than being stuck in hospital when they do not need to be there. So with dementia awareness week approaching, is it not time for the Secretary of State to meet the social care needs of people with dementia fully by meeting the funding gap for social care in this Parliament?
Mr Hunt
Let me explain what is happening on that front. In the first five years after 2010, social care funding went down by 1.3% a year—we had a terrible financial crisis that we were trying to deal with—but since then, in the current spending review period, it is going up by 2.2% a year, which is an 8% real-terms increase over this spending review period. I completely agree with the hon. Lady that we need to do a much better job. [Interruption.] Opposition Members talk from a sedentary position about priorities; our priority has been to get this economy on its feet so that we can put more money into the NHS and social care system, and that is what will continue to happen under a Conservative Government.
Social Care Provision and the NHS
Baroness Keeley Excerpts(6 years, 6 months ago)
Westminster HallRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Barbara Keeley (Worsley and Eccles South) (Lab)
Thank you, Dame Cheryl, for calling me to speak; it is an honour to serve while you are in the Chair.
I, too, am glad that we are actually having this debate, now that we have all got here, and I congratulate my hon. Friend the Member for High Peak (Ruth George) on securing this important debate and on the way that she opened it. It is never easy for someone if they are rushing in at the last minute, because they were delayed by something outside their control. Nevertheless, what we heard from her was a comprehensive review of the issues in social care in her constituency, which I found very useful.
In addition, I thank the hon. Member for Glenrothes (Peter Grant), who is the Scottish National party spokesperson, for a thoughtful contribution. Broadly, I do not disagree with him, but part of the difficulty for Opposition parties is that we have some very substantial disagreements about spending priorities, which is what we end up talking about quite a lot.
Before discussing the effect of social care on NHS provision, which is the topic of our debate today, I pay tribute to both our hardworking NHS staff and the 1.4 million dedicated staff working in care, many of whom —as we heard in my hon. Friend’s contribution—are on low pay, undervalued and overworked. I keep that point in front of me, because it is a very important aspect of social care.
Nurses Day is on 12 May and I pay tribute to the outstanding patient care that nurses give, in the diverse roles that nurses have in healthcare teams, ranging from acute care, which is clearly very important to patients, to Marie Curie nurses in palliative care—there are not enough of them—and to Admiral nurses in dementia care, who are very important too.
Today’s debate is an important opportunity to discuss the interaction between social care and services provided by the NHS, but it is always important to keep in mind the positive role that social care plays in the lives of older people and younger people with care needs, because it helps them to live independent lives. The Secretary of State recently told a conference of social workers:
“We need to do better on social care.”
I agree with him, but the Government have had eight years to do better on social care and yet things have got worse. My hon. Friend rightly pointed to the eight years of cuts to council budgets, which have meant that more than £6 billion has been taken from social care budgets since 2010. That is a serious factor.
My hon. Friend talked about how Government cuts to local authority funding have had an impact on social care services in Derbyshire. I understand that there has been a 40% budget cut already, with further cuts happening this year. She also outlined how the clinical commissioning group, which is an important body in the work on integration and commissioning, is now in special measures because it is in the red. In whatever spirit we are approaching this debate, we have to take it on board that cuts have consequences. As we have heard, cuts to social care budgets have consequences for the NHS. For example, they tie up ambulance paramedics when they could be getting to stroke patients—patients they need to get to. Cuts have consequences for the quality of care and the burden that falls on family carers. I will refer to each of those issues.
We have heard about the diminishing care fees that councils are able to pay in light of cuts. That has further destabilised a care sector that, we have to face it, has been described as “perilously fragile”. The Association of Directors of Adult Social Services reported last year that two thirds of councils had seen care providers close in their areas, and that care providers handed contracts back to more than 50 councils. The Competition and Markets Authority has warned that many care homes could find themselves forced to close or to move away from local authority-funded care. As my hon. Friend said, local authority funding is only just covering day-to-day running costs. Just this week in Trafford, care provider Ampersand Care has closed two homes, blaming chronic underfunding of care for older people. It claims that it cannot provide safe care at the rates offered by Trafford Council. Those closures will see 78 residents face the upheaval of moving from their current home. The reality of our unstable care market is that such instances are becoming commonplace. In fact, just a few weeks ago the same care provider closed a care home in Swinton in Salford, which is my local authority. Now that care provider has only one care home left in the country.
There is a growing funding gap in social care that must be filled. We would not be suffering quite so badly from these issues if we addressed that. The Local Government Association has estimated that our social care system needs an immediate injection of £1.3 billion to fill the gap, and the King’s Fund reports that that will rise to £2.5 billion by 2020. What Members said about the different views people have was interesting. Cuts to social care have led to what the Secretary of State recently described as “unacceptable variation” in the quality of services. We will never address the future funding of social care while we have a quality problem. If we are expecting people to pay more, why should they pay more for services that are not good quality?
As my hon. Friend the Member for High Peak said, one in five care facilities receives the lowest quality rating from the Care Quality Commission. My party’s research revealed that more than 3,000 care facilities with the lowest quality ratings continue to receive the lowest ratings, even after being re-inspected by the CQC. The care facilities find themselves unable to get out of that situation. Cuts mean that providers have less money to pay staff and to invest in training or building renovations, and that can lead to what we are seeing now. Facilities are getting trapped in a cycle of poor quality care provision.
Care staff, who so often are underpaid, undervalued and overworked, are under intense pressure as a result of cuts. My hon. Friend spoke about the challenges with social care in her own constituency, much of which is rural. Many of the problems she described relate to staffing, and they are not isolated examples. Rural England’s 2017 report, “Issues Facing Providers of Social Care at Home to Older Rural Residents” discusses the challenges facing social care provision at home for people in rural communities. Rural populations are typically older. There is a lack of specialist housing for older people and housing stock is older, which may mean it is difficult to heat. Those challenges are compounded by difficulties in recruitment and retention, as we have heard today. Home care staff are typically being employed on zero-hours contracts and receiving payment for actual contact time only and not for travel time. That is true in London and Salford, but in rural areas, where the distances are much greater, that lack of paid-for travel time is a different issue. It could make the difference between people being prepared to work in care or not.
In addition, rural social care has to contend with such factors as a small pool of potential employees, competition from other employment sectors and a mismatch between the locations of care staff and those of people who need care. My hon. Friend gave an important example of one town where 19 people are waiting for a care package. Other national trends affecting the care sector also affect rural areas. They include: low pay, few career opportunities or chances to gain skills, and the increasingly complex needs of people in need of care.
People who need care in rural communities need the Government to think ahead and monitor emerging trends properly to ensure that there is proper coverage in their areas. Worryingly for the future of provision in these areas, Rural England’s report
“found scant regard to rural proofing”
in the sustainability and transformation plans that it had seen. Moreover, it said that:
“published statistics seldom provide, or...facilitate, any rural analysis.”
That needs to be rectified if rural social care needs are to be more than just an afterthought.
We have heard that a lack of good-quality care places an additional burden of caring on unpaid carers. Older rural residents are more likely to provide some form of care to one another—24% of people in rural areas do that, as compared with 18% in urban areas. The issues for carers are more marked in rural areas. I have worked on carer issues since 2002, when I worked as an adviser to the then Princess Royal Trust for Carers, which is now the Carers Trust. That work included the then largest ever national survey of carers to assess the impact of the Labour Government’s carers strategy, which was published in 1999, on carers’ lives. I researched and published three reports on the needs of carers. I wanted to highlight that work from before I was elected to underline how important a national carers strategy is to carers.
I want to raise with the Care Minister how carers have been treated by the Government in recent months with the abandonment of the promised carers strategy. Their needs are being subsumed into the Green Paper on social care for older people, and I want to highlight how one carer feels about that. Katy Styles is a carer and a campaigner for the Motor Neurone Disease Association. She contributed to the Government’s consultation on the national carers strategy because she hoped that her voice would be heard, alongside the 6,500 other carers who also contributed their views. She told me:
“Not publishing the National Carers Strategy has made me extremely angry. It sends a message that carers’ lives are unimportant. It sends a message that Government thinks we can carry on as we are. It sends a message that my own time is of little worth.”
Katy Styles started an e-petition on the issue. It is e-petition No. 209717, which is titled:
“Government must publish a Carers’ Strategy and not a Carers’ Action Plan”.
She sent me this message yesterday:
“Whilst unpaid carers save the UK economy an estimated £60 billion annually, this government fails to value our contribution.
As unpaid carers struggle financially, government fails to give them a reasonable allowance. Whilst unpaid carers spent precious time informing a Strategy, that time and effort was wasted as that Carers Strategy was apparently scrapped. That’s how much carers’ lives matter.
A national strategy would set the tone on how society should value and support carers. Without a strategy, carers have no hope of being valued and supported.”
I support Katy Styles and her campaign. She and other carers do not have much time to spare, and when they do respond to a Government consultation, their input should not be abandoned. As I mentioned last week in our Opposition day debate, this Government have launched more than 1,600 consultations since 2015. More than 500 of those consultations have not yet been completed, and it is sad to note that that includes the carers strategy.
Thinking of ourselves as a group of politicians, we have to be careful that we do not over-consult people. We cannot throw out consultations and reviews as things for people to respond to and then not care whether they get any review of their input or not do anything with what they say. The day that people feel it is not worth putting their time into consultations will be a serious point for us as politicians. It is important that people believe that their input is valued and that we take what they say into account.
I have only been a remote carer, but I feel that I have worked enough with carers to understand their issues. We should take what they say seriously. I hope the Minister can say more than what she has said in the past, which is that a carers action plan will be published shortly. Can she tell carers such as Katy Styles why the planned carers strategy was abandoned?
The funding crisis in social care also has an impact on the growing number of people who are in need of care, but get no care at all, as the hon. Member for Glenrothes mentioned. We know that more than 1.2 million people, many of them isolated and lonely, are now living with unmet care needs. Recent research has recognised that living in rural areas may exacerbate the social isolation of older residents, and of course that goes for their carers too. As the King’s Fund has stated:
“Access to care depends increasingly on what people can afford—and where they live—rather than on what they need.”
The impact of the lack of social care on NHS provision is most regularly seen in the context of delayed transfers of care—my hon. Friend the Member for High Peak talked about the situation in Derbyshire. Although the figures for delayed transfers of care attributable to lack of social care have dropped in recent months, they reached record highs under this Government, causing thousands of people to be stuck in hospital while waiting for arrangements to be made for their care at home, or for a place in a care home. The latest figures, from this February, remained stubbornly high relative to the same period in 2015 or 2011.
It is also open to question whether people are getting the care they need in the community when they are discharged from hospital, a point I raised in last week’s debate. A recent report from the British Red Cross showed that older people could become stuck in a vicious cycle of readmission to hospital because of a lack of adequate care in the community. Reductions in delayed transfers of care will mean very little if there is insufficient social care to support people when they are discharged.
As my hon. Friend said in her speech, a lack of suitable care at home for patients needing palliative care means that people have to remain in hospital to the end of their life, sometimes with heartbreaking consequences. I was glad to hear that at least one person managed to get his wife home for those last few days, because that is very important. However, if many other family members cannot reach the hospital to visit, that is very serious.
The 2015 national survey of bereaved people by the Office for National Statistics found that, while only 3% of those who stated a preference wanted to die in hospital, nearly half of the 470,000 people who died in 2014—some 220,000 people—died in hospital. A 2016 report from Marie Curie found that hospital admissions at that point were unsustainable, and too many people who were approaching death spent long periods in hospital due to a lack of alternative social care support.
I hope the Minister will address that point, and perhaps shed some light on what is being done to reduce the number of people who are denied a choice at the end of their life, in line with the Government’s response to the choice review, which said that the Government
“will put in place measures to improve care quality for all”
and
“will lead on end of life care nationally and provide support for local leadership, including commissioners, to prioritise and improve end of life care”.
From the examples that we heard from my hon. Friend, it sounds as if there remains some way to go on that in Derbyshire.
The social care system now badly needs sustainable funding from central Government, both for the future of the NHS and for the many people who now rely on social care. I remind those few hon. Members who are here that, at the 2017 election, Labour pledged an extra £8 billion for social care across this Parliament, with an extra £1 billion to ease the crisis in social care this year. It is important to keep looking at that figure, because that would have been enough to begin paying care staff the real living wage. It would have helped to ease the recruitment crisis that my hon. Friend has talked about in her area of High Peak, and would have enabled more publicly funded care packages for people with different levels of need. Most importantly, it would have allowed us to offer free end-of-life care to all those who needed it.
I believe we need urgent action to avert the care crisis, and the time to act is now, both for the sustainability of the NHS, which as we have heard is really being affected by shortages of social care, but most importantly for the people who depend on care to live independent, fulfilled lives.
The Minister for Care (Caroline Dinenage)
It is a great pleasure to serve under your stewardship, Dame Cheryl. I thank the hon. Member for High Peak (Ruth George) for securing the debate and setting out the issues so articulately. I congratulate her on making it to the debate, and I thank you, Dame Cheryl, for allowing it to take place. It would have been a great concern to us all if that had not happened.
As hon. Members will know, I am relatively new to my role as the Minister for Care in the Department of Health and Social Care. That is why I am really grateful for the chance to focus on the interface between social care and health, and to outline how integration is absolutely at the heart of what we do. The renaming of the Department of Health as the Department of Health and Social Care must be more than just a change of title; it must provide a sense of direction and a change of culture. We know that health and social care are umbilically linked, and that one is a key driver of the other.
We recognise that many of our challenges stem from the very good news that people are living longer, which is to be celebrated. Worldwide, the population aged 60 or above is growing faster than all other age groups. In developed countries the proportion of the population aged 65 and above is expected to rise by 10% over the next 40 years. That means that, in England, by 2026 the population aged 75 and above, which currently stands at 4.5 million, will rise by 1.5 million. By 2041 it will have nearly doubled.
People’s expectations and wishes are also changing. The traditional model of social care is based on care homes, but we know that increasingly people want care to be delivered in their own homes. We want to encourage people to live independently and healthily in their homes, where many people want to stay. We know that nine in 10 older people live in mainstream housing, and that only 500,000 of those homes are specifically designed for their needs. Adapting homes to make them more suitable is therefore incredibly important. The disabled facilities grant has a vital role to play. Home adaptations and investment can be incredibly effective. Not only do such adaptations allow people to lead independent healthy lives, but our analysis shows that for every £1 spent, more than £3 is recouped, mostly through savings to the health and care system. Housing that enables people to live independently and safely allows us to reduce the number of people who need to go into hospital or have other social care requirements.
We have to look at the way we provide and fund services for the long term. Complex conditions must be addressed, and we must move to a system in which care, whether social care or health care, is individually tailored to people’s needs. The hon. Member for Glenrothes (Peter Grant) put it beautifully when he talked about how we need to stop using social care and our health service as a political football. We need to champion where there is good practice, not just talk about where it is bad. We need to look at how we can produce much more person-centred care, where we address an individual’s needs. We need to celebrate the amazing places up and down our country where it is going right, and we need to support the incredible workforce in this country—both the informal workforce, and the dedicated hospital and social care workforce. A number of pieces of work are ongoing. As the hon. Gentleman said, we need to have the courage to tackle the difficult questions, and that is what is happening.
A number of key pieces of work are happening at the moment to address many of the issues that the hon. Member for High Peak raised. Many of those issues will be tackled in the forthcoming Green Paper. We have an ongoing workforce strategy that is taking place jointly between Health Education England and Skills for Care. In order to address the challenges of our ageing population, we need to attract more people into the workforce. We need to ensure that they are properly rewarded for their work, that there is continuous development within that work, and that we attract people from a much more diverse range of backgrounds.
As the hon. Member for Worsley and Eccles South (Barbara Keeley) said, we also have a carers action plan, which is to be published shortly. She spoke about her constituent, Katy Styles.
Barbara Keeley
The person I was talking about is not a constituent; she is a national campaigner for the MND Association, and she has an e-petition. It is important to note that she is running a national campaign.
Caroline Dinenage
I am grateful to the hon. Lady for clarifying that. I would say to Katy Styles that the decision about whether it is called a strategy or an action plan was taken before I was in my role, but an action plan sounds to me like a much more positive thing.
Actions speak louder than words. We are talking about not just a sense of direction, but what we are doing and how we intend to do it. That is why the carers action plan will be a really important piece of work. I massively value the work of carers up and down the country—indeed, my mother was one—and I want to ensure that we properly recognise and reward what they do. We must be doing what we can, and not just through the Department of Health and Social Care but in collaboration with colleagues across Government, to help and support carers and ensure that the issues they face on a daily basis are tackled.
Barbara Keeley
It is worth clarifying this point while the Minister is talking about the action plan. I told her that I did that piece of work years ago on the first national carers strategy, which came out in 1999 and went right across Government. The difference I see is that that was signed by many Departments, with commitment from those Secretaries of State, but the action plans under the coalition, and those we have seen recently, are just signed by Social Care Ministers; they are very much smaller things. Departmental action plans are not the same as cross-Government national strategies, and I understand why carers feel that strongly.
Caroline Dinenage
The hon. Lady has a surprise coming—this action plan is signed by Ministers from across Government.
The hon. Member for High Peak raised cost pressures. We can all admit that local authority budgets have faced pressures in recent years. They account for about a quarter of public spending, so they have had a part to play in dealing with the historic deficit that we all know we inherited in 2010. That means that social care funding was inevitably impacted during the previous Parliaments. However, with the deficit now under control, we have turned a corner.
Thanks to a range of actions taken since 2015, the Government have given councils access to up to £9.4 billion of more dedicated funding for social care from 2017-18 to 2019-20. Local authorities are therefore now estimated to receive about an 8% real-terms increase in access to social care funding over the spending review. In Derbyshire, the hon. Lady’s local council has seen an increase of £33 million in adult social care funding from 2017-18 to £201.8 million, which is above the 8% figure—it is a 10.3% increase on the previous year. The Care Act 2014 places obligations on local authorities and the extra funding is designed to help them meet those obligations.
Social Care
Baroness Keeley Excerpts(6 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Barbara Keeley (Worsley and Eccles South) (Lab)
I beg to move,
That this House notes that Government cuts to council budgets have resulted in a social care funding crisis; further notes that Government failure to deal with this crisis has pushed the funding problem on to councils and council tax payers and has further increased the funding gap for social care; is concerned that there is an unacceptable variation in the quality and availability of social care across the country with worrying levels of unmet need for social care; and calls on the Government to meet the funding gap for social care this year and for the rest of this Parliament.
It has been six months since the House called on the Government to commit the extra funding needed to ease the crisis affecting social care—six months of missed opportunities for the Government to bring more stability to our fragile social care system; six months in which the situation has deteriorated further. The care of older people and of younger people with disabilities seems sometimes to be an afterthought for this Government. The Secretary of State finally made a speech about social care in March, having had the words “social care” added to his title two months previously. Indeed, he told a conference of social workers:
“We need to do better on social care”.
This Government have had eight years to do better on social care.
The simple fact is that since 2010, things have got manifestly worse. I told the House in October that the care system, in the words of the Care Quality Commission, remains at a “tipping point”. Eight years of cuts to council budgets has meant that over £6 billion has been lost from social care budgets since 2010. The diminishing care fees that councils are able to pay in the light of those cuts have further destabilised the care sector, which is already described by the Association of Directors of Adult Social Services as “perilously fragile”.
ADASS reported last year that two thirds of councils had seen care providers close in their areas and that more than 50 councils had contracts with care providers handed back to them. A major chain of care homes, Four Seasons, recently ran into financial trouble, bringing with it the threat of care home closures and uncertainty for thousands of vulnerable elderly people. A few days ago, Allied Healthcare, one of the country’s biggest providers of home care, announced that it would be seeking a financial rescue plan from its creditors. Allied Healthcare has contracts with 150 councils and it cares for over 13,000 older and vulnerable people, so the Minister needs to tell the House how local authorities will be able to discharge their statutory duty to deliver care if Allied Healthcare collapses.
Mr Jim Cunningham (Coventry South) (Lab)
On local authorities, my hon. Friend will know as well as I do that because of the cuts to local authority budgets, there is, on the one hand, bed blocking in hospitals, because local authorities do not have enough social workers to prepare a care package, and on the other, when people can go into care, care is so expensive that they cannot afford it. Councils are under pressure to try to make up the shortfall, which they cannot do.
Barbara Keeley
Indeed they cannot, and given the fragility in some of these private care providers, I wonder what on earth councils are supposed to be able to do.
Norman Lamb (North Norfolk) (LD)
Does the shadow Minister agree that Allied Healthcare looks like the tip of the iceberg? So many care providers are contemplating getting out of the publicly provided social care market or have already done so that we run the real risk of drifting towards a situation in which people with money can get good care privately but those who do not have the money could be left without.
Barbara Keeley
That is almost the situation we are in at the moment. It is worth thinking about why we seem to have this issue with Allied Healthcare, given that the problem has occurred in the last few days. It was reported that Allied Healthcare’s cash-flow problems had been triggered by increases in the national minimum wage for care staff and by an £11 million bill for back pay owed to sleep-in care staff. However, Allied Healthcare is not the only provider that is facing a large back-pay bill for care workers on shift. Learning disability social care providers have warned that they will have to withdraw services or close altogether to pay the bill for back pay, placing the care of even more people in jeopardy and putting care staff jobs at risk.
This trend of closures and contract cancellations is set to continue. A recent report into residential care by the Competition and Markets Authority painted a bleak picture of the current care home market.
Alex Sobel (Leeds North West) (Lab/Co-op)
I recently met Lifeways Group, which looks after thousands of people with learning disabilities and has many hundreds of staff who do sleep-in shifts. It pays above the national living wage and is a good employer, but it cannot afford the back-pay claims if the finding goes against it. Should the Government not provide the funding to support these organisations?
Barbara Keeley
It is reported, in fact, that the total back-pay bill across the social care providers that provide sleep-in cover will be about £400 million, so it is not surprising that a care provider such as Lifeways would say that. The Government have to come up with answers for this, because there has been a dragging of heels, the guidance has been very confusing, and it is a serious matter. I understand, too, that the Government have completed two reports, but they have not been made public. Hon. Members and I would certainly welcome having those reports placed in the Library so that we can get that information.
We have seen warnings from the Competition and Markets Authority that care homes would find themselves having to close or move away from local authority-funded care because the funding is now only just covering day-to-day running costs. It is quite clear from all this that there is a growing funding gap in social care that must be filled. The Local Government Association has said that our social care system needs an immediate injection of £1.3 billion to fill that gap, and this is projected to rise to £2.5 billion by 2020, according to the King’s Fund.
In our last Opposition day debate on social care, in October, the strain social care was under—from the weight of growing demand, reducing supply and the lack of funds from Government—was plain to see, but since then the system has cracked still further under the pressure of Government funding cuts.
Thelma Walker (Colne Valley) (Lab)
When elderly people fall, they often have a stay in hospital, putting additional pressures on the NHS, and when they are ready to be discharged, hospitals sometimes cannot discharge them, because local social care provision is not available. Two thirds of admissions to hospitals for falls could have been averted by early intervention in the home. Does my hon. Friend agree that we need more money for our adult social services?
Barbara Keeley
I do absolutely—and that is the point I was making. It was only when the number of delayed transfers of care hit a record high that the Government started to pay much attention to this issue. The other worry is that, as the British Red Cross has reported, in attempting to reduce the number of delayed transfers of care, hospitals often eject people before they are ready. One can see a vicious cycle of admission and readmission.
As I was saying, the system is beginning to crack. Hard-pressed councils and their associations are pleading for more funding to deal with the ever-increasing demand for social care. In December, the former president of ADASS, Margaret Willcox, said:
“The crisis facing us is so acute that we fear social care could pass the point of no return in 2018 while we wait for decisions to be made.”
The National Audit Office has warned that councils could face insolvency after using their reserves just to meet those increasing costs of social care. As well as Northamptonshire County Council being technically insolvent, we recently learned that Worcestershire County Council has a massive budgetary disparity. A report from the Chartered Institute of Public Finance and Accountancy has warned the council that it faces a £26 million hole in its finances this year and that that would rise to £60 million in 2020, owing mainly to an increase in demand. The council chief executive, Paul Robinson, has said that
“there comes a point where cost-cutting can’t go any further – there has to be a solution, and I think it has to be a national solution.”
Lord Porter, the Conservative chair of the LGA, has said to councils that:
“you can’t keep dipping into your savings; sooner or later the money will run out.”
Let us think about what these cuts to social care mean for the quality of care that people receive. In the recent words of the Secretary of State himself, there is unacceptable variation in the quality of services. One in five care facilities receives the lowest quality rating from the Care Quality Commission, and Labour’s own research has revealed that over 3,000 care facilities that already have the lowest quality rating continue to receive the lowest rating even after being re-inspected. Cuts mean providers have less money to pay staff or to invest in training or building renovations, which can obviously lead to their getting trapped in a cycle of poor-quality care provision, and that poor-quality care has a serious impact on the lives of people who need care.
Kate Green (Stretford and Urmston) (Lab)
I am grateful to my hon. Friend for pointing out the very high percentage of care homes being found to be inadequate or requiring improvements—the figure is over 40% in my local authority. Does she agree that in many cases this is about care not being safe in those care settings? The real worry is not just that the settings are a bit grotty but that the care is unsafe.
Barbara Keeley
Yes, indeed. My hon. Friend takes me ahead in what I was going to say, but I know she has been involved with Age UK in understanding the state of care in her own local area, and I applaud her for that. Cuts have resulted in providers giving poor-quality care, and that is having a serious impact on the lives of people who need care. It means people not being washed or going hours without receiving a meal or being given a drink; it means people being left without help to go to the toilet; and in some cases, as she just said, it means people not being given crucial medication.
Care quality has become so bad that Age UK’s recent report was entitled, “Why call it care when nobody cares?” Many Members went to the launch of the report and listened to the older carers who were there. The anger of those older carers who spoke at or attended the event was palpable. Some told me that they and their families were often at breaking point, that they felt betrayed by a system of care that left them with little or no affordable support, and that they faced rising care costs which they described as crippling, although the care for which they paid was often not good enough.
I know that the Minister was present at that event. She may have talked to one carer there, Elaine from Northamptonshire, whose council is battling insolvency. Elaine gave up her job to care and has cared full-time for her husband ever since, but rather than giving her any extra help, the council recently tried to increase the weekly cost of care support at home from £88 to £178 per week. That was another battle for a carer to fight to obtain the care support that she needed at a price that she and her husband could afford.
Labour Members recognise that unpaid family carers need more support. We understand how much families are doing to look after their family members, and how hard that is for many carers but the Government have not even developed an updated national strategy for carers, having scrapped the planned strategy back in October. Since then, they have even failed to publish the action plan that was promised for January. What does that say about their attitude to carers?
John Redwood (Wokingham) (Con)
The motion states that
“there is an unacceptable variation in the quality and availability of social care”.
Where in the country does the hon. Lady think it is really good at the moment?
Barbara Keeley
It tends to be outstanding in the independent sector. Charities in particular can be outstanding, although they are not always so.
The care sector’s funding crisis also has an impact on the growing number of people who need care but are given none at all. More than 1.2 million people are now living with unmet care needs, many of them isolated and lonely, and that number rises to 1.5 million with the addition of people who need assistance with taking medication. Unmet needs can lead to people being forced to wear incontinence pads overnight because there is no one to help them to get to the toilet, which takes away their dignity. The number of older people living with unmet care needs will inevitably rise without an injection of new funding, because of the growing demand for care in our ageing population.
It is clear that the social care system needs sustainable funding from central Government, but the Government’s response to the crisis so far has been to push the funding problem on to hard-pressed councils and council tax payers through the social care levy. The only increase in Government funding has been the paltry £150 million extra for social care in the local government finance settlement. That is nowhere near enough to avert the crisis that the Government have created in social care. Moreover, it was not the new money that councils desperately needed. The Government admitted that the increase would be funded through an expected underspend in existing departmental budgets.
It is clear that local authorities are now facing some of their greatest challenges just to make ends meet. I want to highlight the heroic efforts of Labour councils to protect adult social care in the face of swingeing budget cuts from the Government.
Yasmin Qureshi (Bolton South East) (Lab)
My hon. Friend has referred to Labour councils. In each of the last two years, my local authority, Bolton Council, has had to increase its council tax rates by 3% and 2% respectively in order to fund social care, and it will have to increase them next year as well. It has had a shortfall of £6 million, and has been able to cover it only by increasing council tax, which is really not acceptable.
Barbara Keeley
Indeed. As I have said, the Government have pushed the problem on to councils, which have been forced to use their reserves, and pushed the council on to council tax payers, who have had to pay the levy.
I was talking about the heroic efforts of some councils. Despite budget cuts, which are now running at between 40% and 50%, my local authority, Salford City Council, and neighbouring Manchester City Council have acted to ensure that care providers with which they contract will pay care staff a real living wage, and I know that Labour councils in Lambeth, Southwark and many other London boroughs have committed themselves to paying their care staff the London living wage.
Karin Smyth (Bristol South) (Lab)
As my hon. Friend is mentioning many councils, may I draw her attention to the work of Bristol City Council under Councillor Helen Holland? It is leading an important Proud to Care campaign to encourage more care workers back into sector, particularly at a time of increasing demand and labour shortages. Will she join me in commending Bristol City Council’s work in this area?
Barbara Keeley
I will indeed, because given the cuts that many councils have been facing—I am sure Bristol is the same—these efforts to protect care services are really excellent.
I was talking about those London boroughs that have committed to pay care staff the London living wage, which, at £10.20 an hour, is way above the Government’s so-called living wage of £7.83—a commitment that is no small undertaking. That is a further example of the good that Labour-run councils are doing for the most vulnerable people in their communities. We on this side of the House—this ties in very much with the point that my hon. Friend has just made—see the need for social care to be valued as a career. At last year’s general election, Labour pledged to implement the real living wage for all care staff and to ensure that care staff were paid for travel time, that 15-minute care visits were scrapped and that zero-hours contracts were ended for care staff. Those are important steps, but we know that we have to go much further if we are to improve care quality.
It is clear from the reports of the Care Quality Commission that staffing levels are still a major issue in those care services rated as inadequate or requiring improvement. Much of the care workforce are underpaid, undervalued and overworked, which leads to high turnover and vacancy rates in the sector among care staff and, more importantly, the registered managers who are responsible for overseeing care quality. Improving pay for care staff will help with that, but we also need to commit to improving care staffing levels to reduce the workload pressure and offer better training and career paths.
The National Audit Office has criticised the Government for failing to have an up-to-date workforce strategy for the care sector and for their lack of oversight of workforce planning in local areas. Indeed, the Government have no major workforce strategy for social care. It was the Labour Government who produced the last strategy, in 2009. The head of the National Audit Office has said:
“Social care cannot continue as a Cinderella service—without a valued and rewarded workforce, adult social care cannot fulfil its crucial role of supporting elderly and vulnerable people in society.”
Skills for Care has a budget of only £21 million for care staff training, whereas Health Education England has a budget of £4.7 billion. That disparity in budgets between health and social care says it all about the Government’s lack of priority for improving the quality of social care.
At the 2017 election, Labour pledged an extra £8 billion for social care across this Parliament, with an extra £1 billion to ease the crisis in social care this year. That aimed to relieve the pressure on the social care system. It would have been enough to begin paying care staff the real living wage and would have sought to offer more publicly funded care packages for people with different levels of need. Today’s debate is not primarily about the long-term funding of social care, but Labour has made it clear that maintaining the current funding system is not an option in the long term. Recently, polling by the Alzheimer’s Society has shown that paying for social care is a growing public concern and that there is overwhelming public support for a cap on care costs. The next Labour Government will implement a lower cap on care costs than the cap set under the Care Act 2014. We will also raise the asset threshold to a higher level than under the current system.
Maria Caulfield (Lewes) (Con)
I am listening with interest to the hon. Lady’s opening remarks. I am obviously interested in the cap, in paying care workers more and in raising the threshold, but how would a Labour Government pay for that?
Barbara Keeley
I think there must be an echo, because the hon. Lady asked me exactly the same question in the last debate, six months ago. I said to her previously that there is a range of options that we could use to raise the money, including wealth taxes, an employer care contribution and a social care levy. However, it really is a bit rich of Government Members to raise that question when they have no idea whatsoever how they would take forward any social care developments. Furthermore, there was absolutely nothing in the Conservative party’s election campaign last year about the funding for anything. We had a costing document. We had a costed manifesto. I can stand here and say that we had the funding to put £8 billion extra into social care in this Parliament, including £1 billion this year. The Conservative party said nothing whatsoever about that.
Barbara Keeley
I will not give way—I need to move on. When the Minister responds to the debate, she can tell us what the Conservative party is aiming to do, but I am afraid that there has been a complete cloud of obfuscation.
Barbara Keeley
No, I need to move on. The Deputy Speaker has asked me not to take too long, and not take too many interventions. I have been very generous up to this point.
We believe that the time to act on this care crisis is now, but instead of taking the bold steps needed to fix the crisis, this Government are promising a Green Paper. Since the royal commission first reported on the long-term funding for the care of older people in 1999, we have seen 12 consultations and four independent reviews, so I really question why the Government are undertaking yet another consultation and producing yet another Green Paper. It is clear that they have become increasingly fond of consultations, reviews and Green Papers. In fact, they have launched more than 1,600 consultations since 2015, and more than 500 of them have not yet been completed. Sadly, I have to say that that includes the carers strategy. The Government spent £1 million on the Dilnot review, only to delay the introduction of its recommended care cap before shelving it indefinitely. The Government are wasting time and public money on consultations, and even more on adopting then shelving long-term funding solutions for social care.
The time to act is now. I urge the Government to give our social care system the funding it so badly needs, both this year and in the longer term, and I urge hon. Members to support our motion tonight. We must give councils the proper funding to deliver the high-quality care that people across this country need to live with dignity. That is nothing less than they deserve.
The Minister for Care (Caroline Dinenage)
I thank the hon. Member for Worsley and Eccles South (Barbara Keeley) for introducing the debate. We want this to be the best country in the world in which to grow old and in which people can face their third age knowing that they will be supported to live healthy, independent lives for longer and for as long as possible, with a choice of good-quality, affordable care that is there, should they need it. Today’s debate is a welcome opportunity to cover the action that this Government have taken to improve social care, highlighting a few examples where real progress has been made, as well as discussing our longer-term plans for the Green Paper, which will be published later this summer.
Most of all, however, I want to do something that the hon. Lady forgot to do, which is pay tribute to the extraordinary people—both the social care workforce and the informal carers—who play such a vital part in our health and social care system. At the heart of their endeavours is the commitment to do all they can to support individuals and families throughout the country.
Barbara Keeley
The Minister has just said that I did not pay tribute to informal carers. That is just not true. Everybody who knows me knows that I have never stopped paying tribute to informal carers, and I did so in my speech today. Please will the Minister not attribute comments to me that I did not make?
Caroline Dinenage
What I actually said was that the hon. Lady forgot to pay tribute to the social care workforce, who play such a vital part in our health and social care system. At the heart of their endeavours is the commitment to do all they can to support individuals and families throughout the country to live healthier lives with comfort, dignity and respect. However, it is absolutely right to begin by acknowledging that this sector has been through some really difficult times.
Caroline Dinenage
If the hon. Lady will bear with me, I will come on to discuss that, but there will be a separate, parallel workstream on working-age adults, who account for over half of the spending—
Caroline Dinenage
If the hon. Lady will give me the courtesy of allowing me to finish my comments, I will explain why in a moment.
The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) wondered why we are going back to the past and looking at Labour’s record, but Labour is asking people up and down the country to vote for them in the local elections, so they will rightly look at Labour’s record and at how it dealt with the social care crisis when it was in government. After 13 years of inactivity and bluster, people need to be able to make a choice based on historically accurate facts.
Caroline Dinenage
The hon. Lady had plenty of time to make her comments, so I will make a little progress.
When the Conservative party formed the coalition Government in 2010, it is worth remembering that not only did we have to deal with the parlous state of the country’s finances, but we inherited a burning platform of social care. Of course, that meant taking difficult decisions in those early years, which were challenging times for local authorities.
Caroline Dinenage
I will make a bit of progress.
The shadow Minister asked about Allied Healthcare. She is right to raise that, and I am grateful that she has done so. As she said, Allied Healthcare announced last Thursday that it is proposing a company voluntary arrangement to its creditors. I want to talk about that specifically because people across the country will be concerned. I spoke to the chief executive officer last Thursday to emphasise the importance of continuity of care for everyone receiving its services, both in adult social care and primary care, and the company has made it clear that those who receive services from Allied Healthcare will continue to receive the same level of care and that their care plans will not change.
Barbara Keeley
I am glad the Minister has responded in that way, but I asked her how she would ensure that 150 councils can fulfil their statutory duty to provide care if that company goes bust. We need to know a bit more than that she has had verbal reassurance. Of course the chief executive, in his current position, will try to give her verbal reassurance but, under the CVA, the creditors have to be satisfied within four weeks. What is going to happen if this company goes bust? Is it going to be another Southern Cross?
Caroline Dinenage
I am happy to answer the hon. Lady’s questions, which she is right to ask. Although we are very hopeful that this procedure will have a positive result, we are taking steps to ensure we are prepared for all eventualities. The Care Quality Commission and my Department are monitoring the situation, and the CQC will notify local authorities in the event it considers it likely that services will be disrupted as a result of business failure. The law means that local authorities will step in to meet individuals’ care and support needs if a care provider business fails and its services are disrupted. The relevant local authorities are working up contingency plans to ensure individuals’ care and support needs continue to be met.
While the long-term options are being resolved, it is right that funding for social care comes from a variety of sources, including business rates, general taxation and the social care precept. Delayed transfers of care is one area where that money is clearly making a difference. This Government are clear that no one should stay in a hospital bed for longer than is necessary; doing this removes people’s dignity, reduces their quality of life and leads to poorer health and care outcomes.
Barbara Keeley
The Minister is just proving that she was not listening to what I was saying. What I said was that the British Red Cross has said that it had found innumerable cases where discharges have happened so quickly that people were discharged without the right amount of care, and that can just lead to a cycle of readmission. A constituent told me that, in the case of Salford Royal, which is an excellent hospital, she felt she had been “thrown out of hospital.” That is what she told me.
Caroline Dinenage
I very much thank the hon. Lady for that clarification.
Our funding increases have gone into initiatives such as the better care fund, which provides a mechanism for local authorities and clinical commissioning groups to pool budgets for the purposes of integrated care.
Damian Green
I will certainly give way to the right hon. Gentleman in a moment, because I am about to mention him, but I am conscious of time.
There needs to be radical change, and the Green Paper needs to be radical and brave, because although in this debate, as in the wider debate on this issue, a lot of people talk about the fact that we live in an ageing society, we have not remotely adjusted as a society to what that means yet. Our population is projected to grow by around 10 million over the next 40 years. Almost all that growth comes from older people, and particularly those in the oldest age group. There are 5.3 million people over 75 in Britain today. That number will double to more than 10 million in 40 years. This is not just a looming problem; it is a problem today. There is a short-term and a long-term problem to solve. Frankly, in the spirit of non-partisanship, no party has a record unblemished by using social care as a political football. Phrases such as “death tax” or “dementia tax” make good copy and can affect the outcome of elections, but they do not help rational debate or, more importantly, help us improve the lot of the increasing millions of older people.
Barbara Keeley
I wonder whether the right hon. Gentleman is admonishing his own Chancellor, who used the expression “death tax” in the last Budget.
Damian Green
I think that the phrase “death tax” dates back to the previous Labour Government’s attempt to solve the problem in 2008, and I am sure that the hon. Lady used the phrase “dementia tax” during the last general election campaign. I hope that she will reciprocate my attempt to be non-partisan—so far it does not feel like it.
In the short term, the challenge for the Government is one of capacity and quality of care. Both problems will become more difficult in the long term. There is a range of things that we must do as a society before people need social care. For example, we need to keep people active for longer, we need to keep them in the workforce for longer, because that is good for their health, and we need to make changes to the planning system so that we can keep them in appropriate housing of their own for longer. In the end, however, the nub of the issue will be funding.
I want to address a point raised by the hon. Member for Central Ayrshire about joining the whole thing up with health funding. I agree with the broad thrust of the 10 principles proposed by the right hon. Member for North Norfolk (Norman Lamb), the hon. Member for Leicester West (Liz Kendall) and my hon. Friend the Member for Grantham and Stamford (Nick Boles) yesterday, particularly the idea of hypothecation, whose time is coming, but I think there is a problem with the idea of simply integrating all health funding and all social care funding.
It is a no-brainer that, organisationally, social care and healthcare need to be much better integrated, so that the individual is not trying to negotiate a very complex system, as the hon. Member for Central Ayrshire said. If we simply roll all the funding together into one pot, however—a sort of national health and social care fund—there are two serious dangers. The first is that social care takes over from mental health as the Cinderella of the health system, never quite at the top of the priority list when money is allocated. The second is that nobody feels that their contribution is related to their personal needs. The effect is that some of the sources of funding that could be made available—I agree with all those who say we need more funding—such as the £1.7 trillion of equity in residential property, of which more than two thirds is held by the over-65s, would be in danger of being permanently excluded, which I think would be a great mistake.
Jackie Doyle-Price
The ruling from HMRC is clear that those on sleep-in shifts are still entitled to the minimum wage, so we are working out a solution to those historical liabilities. We are clear that we expect all employers to abide by the national minimum wage legislation, and I hope that that gives the hon. Lady some clarity on that point.
We can expect the Green Paper to be brought forward, but I also want to address what Members have said about the variation in quality and availability of provision. As has been said, local councils are responsible for responding to that, and the CQC has rated 81% of care services as good, but it is important that we work with those that are performing less well to achieve significant improvements so that everyone is entitled to the best possible care.
I was pleased to hear the contribution of my right hon. Friend the Member for Ashford (Damian Green). His philosophical approach perhaps reflects the amount of time that he has spent thinking about this topic. I associate myself with the comment made by him and several Members across the House about the fact that no one has an unblemished record when it comes to debates about social care. If we are genuinely to come up with a long-term solution, we need a spirit of consensus to take people with us, and people on both sides of the House need to remember that.
In conclusion, we have had a full debate and it will not be the last time that we debate this subject. We are now quite a way down the track when it comes to working up real proposals to bring genuine reforms of the social care system to equip ourselves for a world where life expectancy ends not at 70, but at 100. That will require significant change. We are stepping up to the challenge and will bring forward proposals in due course.
Question put and agreed to.
Resolved,
That this House notes that Government cuts to council budgets have resulted in a social care funding crisis; further notes that Government failure to deal with this crisis has pushed the funding problem on to councils and council tax payers and has further increased the funding gap for social care; is concerned that there is an unacceptable variation in the quality and availability of social care across the country with worrying levels of unmet need for social care; and calls on the Government to meet the funding gap for social care this year and for the rest of this Parliament.
Barbara Keeley
On a point of order, Mr Speaker. The motion that has just been unanimously agreed calls on the Government
“to meet the funding gap for social care”—
widely said to be £1.3 billion—
“this year and for the rest of this Parliament.”
Given that Ministers have agreed to the motion, can you advise when we might expect an announcement from the Government on this important agreement on social care funding?
Mr Speaker
The most pertinent response that I can offer to the hon. Lady—I understand her perfectly legitimate point of order—is as follows. On 26 October 2017—obviously this was done in the light of a number of Opposition-day debates and motions voted thereon—the Leader of the House said in a written ministerial statement:
“Where a motion tabled by an opposition party has been approved by the House, the relevant Minister will respond to the resolution of the House by making a statement no more than 12 weeks after the debate.”—[Official Report, 26 October 2017; Vol. 630, col. 12WS.]
That is the position as things stand. The hon. Lady has registered her point with considerable force, it is on the record, and I do not dispute the fact of what she said about the motion being carried unanimously.
Oral Answers to Questions
Baroness Keeley Excerpts(6 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Caroline Dinenage
The Secretary of State has already had conversations with councillors about this matter, but my hon. Friend is absolutely right to raise it. The Care Act 2014 placed a duty on local authorities in England to promote diverse, sustainable, high-quality care, and it is important for them to continue to do that.
Barbara Keeley (Worsley and Eccles South) (Lab)
The National Audit Office says that our care system is not “sustainably funded”, the Care Quality Commission says that one quarter of care facilities are not safe enough, and care providers cherry-pick to whom they will give care places, and even evict people with advanced dementia on cost grounds. What is the Care Minister doing to address those issues and the sharp decline in public satisfaction with the social care system?
Caroline Dinenage
We know that the sector is under pressure because of the ageing population, but the Government have given councils access to £9.4 billion more dedicated funding over three years. The hon. Lady is right to emphasise the importance of putting power back in the hands of residents and their families, which is why we published a package of measures to ensure and protect consumer protections in the social care sector, and we will continue to look at that very closely.
Psychosis: Early Intervention
Baroness Keeley Excerpts(6 years, 8 months ago)
Westminster HallRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Barbara Keeley (Worsley and Eccles South) (Lab)
As has already been said, and I will echo it, it is a pleasure to speak in this debate with you in the Chair, Mrs Moon.
I also join others in congratulating the right hon. Member for North Norfolk (Norman Lamb) on securing this important debate, and on the way that he opened it. In addition, I thank my hon. Friends the Members for Stockton South (Dr Williams) and for Liverpool, Wavertree (Luciana Berger), as well as the hon. Member for Faversham and Mid Kent (Helen Whately), and the hon. Member for Airdrie and Shotts (Neil Gray), the Scottish National party spokesperson, for their contributions.
Experience of psychosis can be frightening for those affected by it, and for their families. The hon. Member for Faversham and Mid Kent talked about how debilitating and frightening that experience of psychosis can be.
A story that came to my attention was from a woman called Louise, who wrote a blog for Mind, the mental health charity. In that blog, she described her experience of psychosis. She said:
“While everyone was celebrating the Olympics, I was sectioned and spent a week in hospital. I had started to hear voices and was living in a very strange world. Being in hospital was a terrifying experience and I couldn’t understand why I was there or what had happened to me. I thought the nurses were trying to kill me and I refused medication. Eventually, I accepted the drugs and I did recover. I was released after a week and received treatment in the community.”
The interesting thing about that story and blog is that Louise goes on to say:
“Even a year on, I still find it hard to accept that this happened to me: an independent, strong career woman.”
I wanted to touch on this story because it demonstrates how psychosis affected somebody who was
“an independent, strong career woman”.
The story shows, even in those few words, how debilitating and frightening a first experience of psychosis can be.
Given that, and we have heard about it extensively in this debate, it is clear that early intervention and access to treatment for psychosis is a really vital issue: a moral issue, an emotional issue, a financial issue, and an issue of investment. It is about helping people when they are at their most vulnerable and supporting them to recover.
From this debate alone, the evidence is clear that early intervention can significantly improve a patient’s mental health recovery. That has been highlighted by all the contributions we have heard today. One of the most important benefits of early intervention—this has not yet been mentioned—is the finding in studies that it can reduce the risk of a young person who is experiencing psychosis attempting suicide. That is clearly an important thing. As we have heard, the care packages approved by NICE can also have an impact beyond the mental health recovery of a patient, impacting on their physical health and their chances of remaining in employment. Each part is vital. A key statistic comes from the mental health charity Rethink. It found that 35% of young people in early intervention in psychosis care are in employment, as compared with just 12% of young people in standard mental health care. The right hon. Member for North Norfolk discussed that.
The access and waiting time standard for early intervention in psychosis is not being met, partly because the official figures are for patients who have started treatment. As my hon. Friend the Member for Stockton South discussed, YoungMinds has stated that in January 2018, even though 722 patients had started treatment within two weeks of referral, 1,344 patients were still waiting to start treatment, and 727 of them had been waiting more than two weeks since referral. We are getting a partial picture from NHS England. We were all sent a briefing this morning that said that the access standards are being met, but they clearly are not if they are not taking account of patients who are waiting. The figures for January 2018 also showed that 401 patients had been waiting more than six weeks and still not started treatment, and 217 patients had been waiting for more than 12 weeks without starting treatment. As is familiar when we are looking at issues around mental health, it is the people waiting for long periods who we have to reflect on.
We have also heard about the regional variations. This has been an important debate for highlighting them. The right hon. Member for North Norfolk reported in detail on performance in the south region, which is the best-performing region. YoungMinds reported that the north of England is the worst-performing region. It has the lowest proportion of pathways completed within two weeks of referral.
It is clear that the Government have not invested in the staffing and resources needed to deliver the full package of NICE-evidenced support and treatments. It is clear that many local areas are facing challenges in implementing the early intervention in psychosis access and waiting time standard because of those substantial variations. What is the Minister’s assessment of how those challenges can be overcome? That is one of the most important questions from today.
We have had a briefing this morning from NHS England on the NICE-recommended interventions and the scoring matrix to be used, including on carer support. The hon. Member for Airdrie and Shotts mentioned carers, but I will discuss the subject a bit more fully. Psychosis can cause considerable distress not only for the person experiencing it, but for their family members who are carers. Why are the targets for carer support so low within that NICE evidence package? The figures that NHS England sent to us this morning show 38% of carer support taken up against targets of 25%, 50% and 75% for 2017-18. Take-up of support by fewer than four out of 10 carers is a poor achievement, given the impact that psychosis can have on unpaid carers.
I do not want to miss the opportunity to question the Government about the shameful way they have been treating carers in recent months. I have raised this before with the Minister, but the Government have abandoned their promised carers strategy after 6,500 carers gave up their time to contribute to the consultation. I know it is not her responsibility any more, but it was at the time, and she gave this reply to me in December. She said that,
“it is very important to pull together exactly what support there is at present and then respond to that, and we will publish our action plan in January”.—[Official Report, 7 December 2017; Vol. 632, c. 1239.]
It is now the middle of March, and we have no carers strategy and no carers action plan. Will the Minister raise the matter with her colleague the Minister for Care, the hon. Member for Gosport (Caroline Dinenage)? I suggest that the Government stop treating carers in this shabby way. In terms of this debate, will the Minister look at the low targets for carer support in the targets for early intervention in psychosis? Will she set a more ambitious target to provide higher levels of support to carers of people experiencing psychosis?
My hon. Friend the Member for Liverpool, Wavertree rightly raised the issue of perinatal mental ill health. As we have just had International Women’s Day, I wanted to refer to the 2003 women’s mental health strategy. It was a comprehensive strategy for women’s mental health issues from the previous Labour Government. I was glancing at the document on my iPad, and section 8.8 is about women with perinatal mental ill health. What has happened to the previous Labour Government’s comprehensive women’s mental health strategy? Does the Minister agree that perinatal mental ill health and other aspects of women’s mental ill health merit a gender-specific approach? Will the Government start to think about implementing that?
I want to briefly touch on one further area of concern—the lack of good-quality data. All of us involved in these debates on mental health have to spend a large amount of time asking parliamentary questions that do not get answers because the data are not there. The right hon. Member for North Norfolk is to be commended for his freedom of information survey. In 2016, Public Health England produced a report into data around psychosis and found what the Centre for Mental Health has described as “massive inequalities” in care, which is just what we have been hearing about in this debate. The report found that the proportion of people who have experienced psychosis who have a comprehensive care plan ranges from around 4% in some local areas to 94% in others. The evidence was there in 2016 that massive variations existed.
As the Centre for Mental Health put it:
“The report is as remarkable, however, for the data it cannot present as for what it can. There is very little information about the lives of people with psychosis and how far the services available help them to recover”.
The report was unable to give any information about the prescribing of anti-psychosis medication. Shockingly, it found that there were no known recent robust estimates of local numbers of people with psychosis. How can we deal with recruitment and staffing issues and the resources plan that Members have talked about if that is the state of the data?
I appreciate that there have been some improvements in mental health data in recent years, but it has been very slow progress and there are still many gaps. The Government talk about parity of esteem between mental and physical health, but it is hard to imagine a situation where we did not know the number of people in a local area being diagnosed with different cancers. That situation just would not arise. When I meet campaigners who work on mental health issues, the lack of readily available data is a constant and major concern.
The former Under-Secretary of State for Health, Nicola Blackwood, liked to talk about accountability through transparency. She said:
“One of the ways in which we are ensuring that money reaches the frontline is through driving accountability through transparency. Mental health services have lagged behind the rest of the NHS in terms of data and our being able to track performance. That is why the NHS will shortly publish the mental health dashboard, which will show not only performance but planned and actual spend on mental health.”—[Official Report, 27 October 2016; Vol. 616, c. 513.]
We still have that severe problem. Despite the publication of the mental health dashboard, we have a far less clear picture for mental health data than we do for physical health. We will never be able to plan, resource or move through these issues unless we do. What is the Minister doing, and planning to do, to make better data available across mental health services, particularly for psychosis?
I briefly return to Louise’s story. She was lucky. She said in her blog that she received good-quality treatment. Despite going through some difficult times, when she wrote the blog she was positive about her future, her relationships and her career. She was looking forward to starting a family. If we want to live in a society that has more positive stories like Louise’s, we have to begin to take a much more preventive approach to mental health. Getting the right support can lead to brighter days.
Mental Health Services: Children and Young People
Baroness Keeley Excerpts(6 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Barbara Keeley (Worsley and Eccles South) (Lab)
(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement on the Care Quality Commission’s review of children and young people’s mental health services.
The Parliamentary Under-Secretary of State for Health (Steve Brine)
Not enough scripture is quoted in this House, but I cannot match what was just said. However, I can tell the House that the Care Quality Commission published its “Are we listening? Review of Children and Young People’s Mental Health Services” report this morning, and, yes, we are listening. It was the second piece of work commissioned by the Prime Minister in January 2017 to look at this area of services, and the findings include examples of good or innovative practice and of dedicated people—we thank every one of them—working in every part of the system and a number of areas with strong practice ensuring that patients and families are involved in planning care, but there are also concerns around the join-up between children’s services. We thank the CQC and Dr Paul Lelliott for their work.
The Government have already committed to making available an additional £1.4 billion to improve children and young people’s mental health services to deliver on the commitments in “Future in mind” and NHS England’s five year forward view for mental health, and the CQC welcomes that progress in its report. I know that the hon. Lady and others have worries about this, but spend is reaching the front line. By 2020-21, we have committed to ensuring that 70,000 more children and young people each year will have access to high-quality NHS mental healthcare when they need it. However, there is so much more to do. Claire Murdoch, the national mental health director for NHS England, said in response to the report:
“CAMHS services are now improving, but from a starting point of historic underfunding and legacy understaffing, relative to rapidly growing need”
We see those things across the service.
In December, the Department of Health, jointly with the Department for Education, published “Transforming children and young people’s mental health provision”. That Green Paper responds to a number of the problems raised by the CQC in this report, and sets out a range of proposals to strengthen how schools and specialist NHS mental health services work together and to reduce the amount of time that children and young people have to wait to access specialist help. The proposals are backed by an additional £300 million of funding. We have carried out extensive face-to-face consultation on the Green Paper proposals and have received a high volume of responses to our online consultation, and we thank everyone for that. We will respond to this CQC review, alongside the Green Paper consultation, in the summer.
The report calls for the Secretary of State to use the inter-ministerial group on mental health to guarantee greater collaboration across Departments in prioritising mental health. We agree, and that recommendation is already in hand. The IMG has already contributed to the development of the Green Paper and will continue to provide leadership on the issues that the report raises. The CQC also recommends that everyone who works, volunteers or cares for children and young people is trained in mental health awareness. We are already rolling out mental health first aid training to every secondary school and have committed to rolling out mental health awareness training to all primary schools by 2022. The Government and Ministers remain wholly committed to making mental health everyone’s business and building good mental health for our children and young people.
Barbara Keeley
The report is the latest piece of recent evidence revealing systematic failures in our mental health services. It follows similar reports of the past few weeks that call into question the Government’s claims to have made mental health a priority equal to physical health. In this report, we see evidence of services actively putting up barriers to treatment, resulting in children and young people having to reach crisis point before being able to get access to the right treatment. Children are suffering because of those high eligibility thresholds. We know that 50% of mental health problems develop before the age of 14 and that 75% develop before the age of 18. Does the Minister recognise that imposing high eligibility thresholds means that children and young people are treated only when their condition becomes more serious? These high thresholds are even prompting GPs to tell children to pretend that their mental health is worse than it is. Will the Minister agree to look into referral criteria as a matter of urgency, so that children and young people get the proper treatment at the right time?
The report links these excessively high eligibility thresholds and reductions in access with funding reductions and not enough capacity for services to respond to local needs, so, whatever the Minister says, clearly not enough money is reaching the frontline. Can the Minister tell us how he plans to address that? The report, like the CQC’s recent report on rehabilitation services, raises concerns about out-of-area placements, which we know are a barrier to recovery. Will he tell the House what action is being taken to increase the number of in-patient beds available locally?
Finally, what will the Minister do to address the clear problems, highlighted in this report and others, associated with the rigid transition at age 18 from child and adolescent to adult mental health services, which is also a barrier to accessing care?
Steve Brine
The hon. Lady rightly raises the issue of spend reaching the frontline; I said in my opening remarks that it is doing so, and she asked what evidence there was of that. Last year, there was a 20% increase in clinical commissioning group spend on children and young people’s mental health, rising from £516 million in 2015-16 to £619 million in 2016-17.
On the broader issues raised in the hon. Lady’s response, I said that we have made up to £1.4 billion available over five years to support transformation of these services, and there is the additional £300 million that I mentioned. I want to touch on waiting times, referral routes and workforce. We are the first Government to introduce waiting time standards, and that is relevant to children and young people’s mental health, too. We are meeting, or on track to meet, both targets. We will pilot a four-week waiting time for specialist children and young people’s NHS mental health services, as was outlined in the recent Green Paper. As I say, we are considering responses to that.
On referral routes, our Green Paper proposes senior designated leads and mental health support teams—a new workforce—based on the findings of the Department for Education’s schools link pilot. They aim to improve the join-up with specialist services and to result in more appropriate referrals.
Steve Brine
The hon. Lady shakes her head; I can only tell her the facts. Health Education England’s workforce plan recognises new ways of working as a cornerstone of delivering these improvements. HEE will also work with our partners to continue the expansion of these newly created roles in mental health services, and to consider the creation of new roles, such as that of early intervention workers, who would focus on child wellbeing as part of a psychiatrist-led team.
Points of Order
Baroness Keeley Excerpts(6 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Speaker
I will come to the hon. Gentleman, but I have another point of order first.
Barbara Keeley (Worsley and Eccles South) (Lab)
On a point of order, Mr Speaker. In an oral statement on social care on 7 December 2017, the then care Minister, the hon. Member for Thurrock (Jackie Doyle-Price)—as it happens, she is in her place on the Front Bench at the moment—replied to a question I asked about the Government abandoning the carers strategy, which had been due to be published in summer 2017. Of the thousands of carers who had responded to a consultation and then been left waiting, the Minister said:
“We have listened to them, and we will consider what they have said in bringing forward the Green Paper. In the meantime, it is very important to pull together exactly what support there is at present and then respond to that, and we will publish our action plan in January.”—[Official Report, 7 December 2017; Vol. 632, c. 1238-39.]
It is now March, and this is the second time I have raised this on a point of order. Not only do we no longer have any prospect of a carers strategy from the Government, but they have not met their own target to publish an action plan. That is a shabby way to treat carers. Mr Speaker, have you had any indication that the current Minister for Care or, indeed, any Health Minister plans to come to the House to update us on what, if anything, the Government propose to do for carers?
Mr Speaker
I have certainly not been advised of any intention on the part of a Minister to make an oral or, indeed, written statement to the House. There is a Health Minister on the Treasury Bench, who has heard what the hon. Lady said. She is welcome to respond if she wishes, but is under no obligation to do so.
Mental Health Act: CQC Report
Baroness Keeley Excerpts(6 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Jackie Doyle-Price
One of the things that we are doing in prioritising mental health is dealing with exactly that issue. We are having discussions with every part of the health community. We recognise that all the professional organisations have a role in spreading best practice, but we need to do that as well, and the CQC report—and the fact that we are undertaking these reviews so transparently—will help us to do it.
Barbara Keeley (Worsley and Eccles South) (Lab)
Today’s report lays bare the problems that are at the heart of the Government’s short-sighted and incoherent approach to dealing with mental health issues. The CQC has found the system to be “under considerable pressure”, with no improvement in the areas of concern raised in previous reports.
Rather than taking a preventive approach to mental health treatment, the Government have made real-terms funding cuts which mean that more people are at risk of being detained and fewer detentions are being prevented. Crucially, those cuts are causing less restrictive alternatives for the community to be removed at the same time as the reductions in the number of beds for admissions. As the report tells us, the number of detentions under the Mental Health Act 1983 has risen by 36% since 2010, and between 2015 and 2016 it rose by more than 5,000. Will the Minister note that between 2000 and 2009 rates of detention fell, largely owing to investment in community services by the last Labour Government?
Recent research by the Royal College of Psychiatrists showed that mental health services have less money to spend on patient care in real terms than they did in 2012, and more than a quarter of clinical commissioning groups underspent their mental health budgets last year. The Government make many claims about the funds that they have pledged to mental health services—as the Minister has today—but it is clear that the money is not reaching the frontline. The CQC thinks that reform of mental health legislation on its own will not reduce the rate of detention, and reductions in mental health beds and community services are clearly contributing to the rise in the number of detentions. Is it not time to increase funding for mental health, and to ring-fence mental health budgets?
Jackie Doyle-Price
I repeat that we have increased mental health spending by £11.6 billion. The hon. Lady suggested that a quarter of CCGs are spending less than their allocations on mental health, but that is not the figure that I have. We believe that 85% of CCGs have increased their mental health expenditure in excess of their allocations, which does not chime with what she said about community services. It may give her some reassurance to know that from next year, NHS England will ensure that the mental health investment standard forms part of its planning guidance. [Interruption.] The hon. Lady says “Next year”, but, as I have said, 85% of CCGs are already meeting the standard, and those that are not are experiencing intervention from NHS England. We are satisfied that the 85%—and it will be 100% next year—are investing more in mental health services beyond their allocations.
I agree with the hon. Lady, and indeed with the CQC report, that the review of the Mental Health Act is not the entire answer. That is the reason for the CQC’s annual inspections, and we will act on its recommendations, but central to the work that Sir Simon Wessely is leading is identifying non-legislative action that we can take in order to make the system work better, and we are involved in many cross-Government initiatives that will enable us to do exactly that.