Local Authority Grants: Impact of Cuts

Baroness Barker Excerpts

Thursday 9th December 2010 Lords Chamber

[Baroness Barker]

I thank the noble Baroness, Lady Thornton, for the elegant way in which she introduced this debate on a subject that, as she and the noble Lord, Lord Lipsey, know, is one that I care about quite a lot. I also declare an interest as the owner of a consultancy that works with voluntary organisations called Third Sector Business.

Let us not forget that the system of social care was unsustainable and in need of radical reform back in the 1980s, when Mrs Thatcher appointed Sir Roy Griffiths to produce Community Care: Agenda for Action. It was unsustainable and in need of radical reform when, in 1997, Tony Blair appointed, among others, the noble Lord, Lord Lipsey, to produce their report on long-term care, which was then studiously ignored by the Labour Government for the 13 years that they were in office. Here we are now, at the point where our system of social care is unsustainable, not working and unaffordable. We are having to address those questions not, as the Labour Government were, with a significant amount of cash to throw at it, but in the most difficult of economic circumstances. That is the backdrop of events as discussions are going on. That is why the noble Lord, Lord Lipsey, is again wrong—against that backdrop, an extra £1 billion is actually something to be very pleased about.

I want to explain the perfect storm that is enveloping local organisations. At the moment they are dealing with the imposition of the 2010 tendering regulations, which means that there is a huge change in the way in which their services are bought and commissioned by local authorities. The personalisation agenda, which the noble Lord, Lord Low, spoke about, is being rolled out. It is a model of commissioning services that was developed largely for adults with disabilities, people who for the most part have conditions that do not change. It is being rolled out to a far greater number of older people, most of whom need care at a point of crisis, and whose needs change quite a lot and substantially. It is being carried out at a time when the three big clients that those organisations have had are either disappearing or are changing completely. Most of those organisations were funded either by their local authorities or by PCTs, and they are having, in a very short space of time, to completely change what they do and how they do it. Most of them are not big administrative organisations that can suddenly summon in an awful lot of help from major international companies and get them to come in and sort out their systems. They are very small organisations that are having to change very, very quickly.

The NHS is changing too. It is not uncommon for local organisations to carry out their business with partners in the NHS and local authorities where there have been no permanent senior managers making decisions for the past three years. It is extraordinarily difficult to come to any conclusion about what you should do strategically in that situation.

It is also not that simple to bring about change as quickly in voluntary organisations as it is in others. In a commercial company, if your economic outlook is bleak, you simply get out your accounts and forecasts and you study them to determine what you will do. In a voluntary organisation, you have to start from the point of saying to people who you have never charged for services that their services are going to have to be charged for. You have to go through a period of angst with people before you can get them to the point where they can begin to look at what will be a sustainable future. Behind that, local authorities are also beginning to get to grips with new ways of accounting, some of which are very good. The Total Neighbourhood and Total Place accounting systems are extremely good, but are very new.

In the midst of all that, there are organisations that are seeking to continue what they do now, much of which is unfunded but immensely valuable, and trying to make sense of a system in which they can, on a sustainable basis, meet the needs of a growing population—a population which has needs that we are all aware of. The number of people with dementia is set to increase exponentially.

It is against that backdrop that I want to ask the Government, who are right to have a radical approach to social care, whether they will do three things. First, will they give us more detail about the transformation fund? It is way too small. I am not clear on whether the fund will be available for only a year, but I suggest to the Minister that it needs to be available for two years, if it is to be effective. Will the Government specify what the fund is intended to do? Secondly, will the Government look at the capacity and willingness of GPs to commission social care? That will be an extremely important point for the future. I have not yet seen evidence of GPs being familiar with how one commissions social care services and refers people to services which have to be paid for. Many GPs refer people to services, but those services are usually free, and I doubt that that will happen.

Thirdly, will the Government look in particular at the one service—hospital discharge—in which there ought by now to be sound joint working? There is none. We have never had a model of hospital discharge which works properly for the NHS, properly for social services departments which want to do well by people, and, above all, properly for people who are coming out of acute care and who may need longer-term care. If we can do that at a time when the NHS will be judged by a new quality-and-outcomes framework, which does not just reward acute hospitals for the number of high-tech operations they perform but rewards them for the health outcomes that they achieve for a population, we will then be in a position to start to build a system of social care which is sustainable and meets long-term needs.