Social Care

Debate between Christine Jardine and Philippa Whitford

Wednesday 25th October 2017 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

We have all seen the figures about everyone getting older. If we look over the lifetime of the NHS from 1948 to the predictions for 2030, we see that the number of people over 65 will double and the number of people over 85 will increase by 10 times, yet the number of funded places for care has gone down by a quarter. Those two things simply do not match up. As the Minister mentioned, those under 65 with disabilities or learning disabilities are also, thankfully, living longer. The problem is to provide them with care. As a doctor, I obviously tried to do my little bit for people living longer. We should not look at this as a catastrophe; we must celebrate it. We are all heading there, so it is in our own vested interest to ensure that the services will be there for us.

We know that a lot of people’s state of health in older age is laid down in the early years. In Scotland, we are focusing on the early years collaborative—from the baby box for every newborn child, the 30 hours’ early learning entitlement, doubling active transport and rolling out through schools what is called the daily mile. However, we will not get a financial return on that for 50 or 60 years, so we must also invest in our older citizens. In Scotland, we are trying to expand elective services to meet the demand for operations on hips, knees and eyes, but the King’s Fund reports that hip and knee joint replacements are being rationed, and we know that three quarters of trusts have set such strict limits on accessing cataract surgery that people are, in essence, losing their sight, and certainly losing the ability to drive, with half of the trusts fixing only one eye.

Doing such things means driving people into their own homes and into isolation, as well as increasing their need for care and increasing the speed, or lowering the age, at which they need care. It really does not make sense. Age UK points out that 1.2 million people are not getting the care they need, and that matches almost exactly the 1 million family carers who are actually providing the bulk of the care required. In Scotland, we have already committed to raising carer’s allowance from £60 to match jobseeker’s allowance, but that is pretty paltry for someone working, in essence, seven days a week, while 40% of them are reported not to have had any respite or break in a year.

Such a situation arises because the statutory system is not supporting carers, and we need to look at this. Care homes are closing because of the extra costs brought in by the national living wage, and part of that is simply because the price paid is being driven down. As has been mentioned, over half of local authorities are seeing either home care providers or nursing and care home providers closing. The thing is that we need to pay people a decent wage—not the national living wage, but the real living wage. This needs to become a profession that attracts and retains people. Who would we like to look after us or our mother or father—someone who is doing it only for six months until they can get something better, or someone who actually believes in looking after our older population with the greatest possible love, care and dignity?

We need to put in the funding. The Minister talked about the better care fund, which has indeed put in extra money, but that is at the cost of the new homes bonus in England, while local authorities are also being told to build more houses. What are they meant to do? We need to put this on a sustainable footing. We also need to address the issue of those under 65. In Scotland, our programme for government includes a commitment to the under-65s with what is called Frank’s law, in honour of a football player from Dundee who developed early dementia. We have people aged under 65 with the same needs—those with early dementia, multiple sclerosis or motor neurone disease. Why should their birth date dictate whether or not they get help?

[Christine Jardine (Edinburgh West) (LD)]

The hon. Lady is painting quite a rosy picture of the social care system in Scotland, but does she not accept that it has serious problems as well? In my constituency, I know of a gentleman who was in hospital 150 nights after he could have been transferred because no care package was in place. Freedom of information inquiries have shown that people have spent 400 nights in care when they could have been transferred. Does she accept that the picture in Scotland is not entirely rosy?

[Dr Whitford]

I totally accept that the position is not entirely rosy. I said many times in the Chamber before the hon. Lady entered the House that we face the same challenges. Those challenges are increased demand, workforce needs—they will be made significantly worse by Brexit—and the fact that money is tight. We face exactly the same challenges. Some of the patients she refers to will have had particularly complex needs that it was a struggle to meet. We are talking about the fact that we are funding free personal care—it is not based on means-testing—and we are working towards providing it for under-65s.

Everything happening in England at the moment will seemingly be solved by the sustainability and transformation plans, yet they have been set backside forwards, with designers having to work backwards from the budget line, which is made the predominant thing. That will not produce the desired result, and it must be recognised that supporting people at home and in the community is desirable in its own right. None of us wants to be stuck in a hospital or in a care home if we could be looked after in our own home; that is the choice we would all make. That will not necessarily cut the money required by a hospital. The nurses will still be there, the lights will still be on. What it might mean is that that bed can be more effectively used and waiting times for surgery or other treatments can be achieved, and they are not at the moment.

On the news yesterday, there was talk about the inefficiency of operating lists, and the former president of the Royal College of Surgeons clearly said that this comes down to beds. The number of beds in England has been cut in half over recent decades, and the problem is that if a patient cannot be put in a bed before or after the operation, the operation cannot be done. That is often discovered only the day before, and we cannot just drum up another bed.

All sorts of things, not just delayed discharges, are driving inefficiencies within the system. The thing generating the biggest pressure on the NHS has been the cuts in funding to social care that mean that by 2020 in England a funding gap of more than £2 billion will have to be met. We all want to look forward to a dignified older age. We hope that we will be independent and healthy. We need to invest in that, yet public health spending has gone down 5%. Should we need care, we will also want care that is dignified and decent. That has to be funded.