NHS and Social Care: Winter Service Delivery

Baroness Pinnock Excerpts

Thursday 25th January 2018 Lords Chamber

[Baroness Pinnock (LD)]

My Lords, I draw attention to my interests as a local councillor in the borough of Kirklees, and as a vice-president of the Local Government Association.

The stark facts are that in the last winter period, there were an estimated 34,300 excess winter deaths in England and Wales. That is a shockingly high figure and one on which I hope we will seriously reflect. Last October, a joint university research team found that of these excess winter deaths, around 8,000 a year may be caused by “deadly” levels of so-called bed blocking. NHS England regularly reports on delayed transfers, and the latest report cites a number of reasons for them: insufficient capacity in intermediate bed-based so-called step-down care; social care assessments and agreement with families for transfer to residential care; and delays in providing home care support for those who can continue to live in their own homes.

Leaving older people in hospital when they are able to go home has a very high impact on the individual, their family and other patients, as well as additional costs to the NHS, obviously. However, it is hardly surprising that these delays occur with such devastating consequences. Professional bodies and local government have been making it clear for many years that the funding of adult social care is at crisis point. As we have heard, the LGA estimates that there is a £2.3 billion per year shortfall in the funding necessary for adult social care. This figure is confirmed by work done by the King’s Fund. The result is that local authorities have been steadily reducing care costs and defining ever higher eligibility criteria. So across England, spending per adult resident on social care fell by 11% between 2009 and 2016—that is according to the Government’s own figures.

Ten per cent of councils have cut their spending on social care by 25%. Think about what that means to vulnerable older people who need social care in those areas. Councils serving more deprived areas have had to make even deeper cuts to social care budgets, despite clear evidence of efforts to protect social care spending. The more deprived an area, the higher reliance on government revenue support grant, hence the larger the cut in the spending power of these councils, as the Government, year on year, cut the revenue support grant to fund them. Local authorities have had to respond to much reduced budgets by putting pressure on the costs of local authority-funded residential care and home care. The result is not surprising: care homes cross-subsidise by higher payments from self-funders. That is a scandal waiting to hit the headlines.

Rationing has resulted in the number receiving care falling by 25% between 2009 and 2014—and I am sure that that has risen in the couple of years since then. Consequently, older people are struggling for longer on their own and the tendency is for this to escalate into more acute episodes requiring acute care in hospital. It is quite obvious that a significant part of the solution is for the Government to provide adequate funding for adult social care.

The Government’s response to this crisis of funding has been woeful. A much-publicised £2 billion has been added to the social care budget, but that is over three years—in other words, a mere £600 million a year in the face of a need for £2.3 billion a year. The additional £1 billion provision in the 2017 Budget has come with very long strings attached. A lot of it has gone not to adult social care budgets but to the better care fund, which is about collaboration between the NHS and social care services. The Government have decided, in the face of this funding crisis, to put the burden of social care costs on to what they have previously described as “hard-pressed council tax payers”.

Councils are able to charge a 3% social care precept for two years, but council tax is a regressive tax system that takes no account of ability to pay. Furthermore, a council tax rise of 1% raises very different amounts according to the rateable values in the council district. So 1% in my own borough of Kirklees raises £1.6 million, and a 3% rise barely covers inflation. The consequence is that Kirklees Council will, reluctantly, further reduce expenditure on adult social care this year.

The Government have enhanced funding for the NHS and social care through the better care fund but, in my experience, the NHS and local authorities have, quite rightly, used this fund to develop more collaborative approaches, which do not impinge on the immediate crisis. Does the Minister accept that adult social care funding needs to be substantially increased year on year to meet the shortfall predicted by 2020? I look forward to him providing some positive hope in the promised Green Paper of the Government’s willingness to accept the crisis for what it is: a consequence of inadequate funding.