NHS and Social Care Funding

Lord Soames of Fletching Excerpts

Wednesday 11th January 2017 Commons Chamber

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

I want to start by paying tribute to our hard-working staff in the NHS and those in the care sector. The best way to thank those staff would be by giving them the resources they need to do the job we want them to do.

I welcome the contributions made by hon. Members today, particularly the moving contribution from my hon. Friend the Member for Chesterfield (Toby Perkins), who bravely told us about the personal catastrophe for him and his family when his father was sent home from a pressured A&E, sadly to die from an aneurysm. My hon. Friend the Member for Workington (Sue Hayman) was able to tell us about the happy death her father had with the end-of-life care at the local community hospital.

The hon. Members for Central Ayrshire (Dr Whitford) and for Totnes (Dr Wollaston) both emphasised the complexity and frailty of patients needing care in the winter months. We should remember that in terms of the scale of pressures facing the NHS. Both those Members supported the four-hour target for A&E as a barometer of the wider system pressures in the NHS: a measure of how the system is managing to process those frail and complex patients. My right hon. Friend the Member for Doncaster Central (Dame Rosie Winterton), as a former Minister for emergency care, urged the Government not to give the NHS the impression of giving up on the four-hour target, as that sends the wrong message. At our NHS leaders’ summit yesterday, we heard a real concern that, for instance, parents might be discouraged from taking their children to A&E.

Conservative Members have cited both Simon Stevens and Chris Hopson in support of their claims on NHS funding, but I would like to update them, because in the House this afternoon Simon Stevens said that

“we got less than we asked for”

and that the Government are

“stretching it to say the NHS…got more”.

He also said that it does not help anybody to pretend there are not financial gaps. Chris Hopson, of NHS Providers, said:

“No, we don’t believe the NHS has got all the money it needs”

and that the NHS is not sustainable on current funding.

I turn now to the pressures on the NHS caused by social care. The crisis in our hospitals has been made much worse by the Government’s continued failure to fund social care properly. The care crisis is caused by insufficient funding in the face of growing demand, and Ministers have ignored warnings from a wide group of doctors and from leaders and professionals in the health and care sectors. The Government failed to produce a single penny of extra funding for social care in the autumn settlement. Then they told us that extra funding was being made available for social care in the local government funding settlement, but this was not the extra funding so desperately needed from central Government—what Ministers did was to shift the burden on to council tax payers. That was made worse by the fact that the £240 million adult social care grant was actually money recycled within local government budgets, from the new homes bonus. One third of councils will be worse off as a result of this settlement; my own local authority, Salford, will have £2.3 million less in its budgets. This is not a boost to social care.

What health and social care leaders had pleaded for was for Ministers to bring forward funding promised for 2019 to address the current crisis in social care, and that is what today’s motion proposes. That would provide some breathing space, which is needed because the lack of social care means that thousands of older people are stuck in hospital waiting for a care package in their own home. That was the most common cause of delayed discharges caused by social care. More than a third of the record 200,000 delayed days most recently reported were due to lack of social care. Being stuck in hospital not only affects patient morale and mobility; it increases the risk of the patient getting hospital-acquired infections. The major impact, though, is the knock-on effect on people in A&E who are waiting for a bed for an emergency admission.

Health Ministers like to blame local authorities for the lack of social care, but there are problems with that. When NHS chief executive, Simon Stevens, gave evidence to the Communities and Local Government Committee’s recent inquiry into social care, he was asked by the Chair, my hon. Friend the Member for Sheffield South East (Mr Betts), what extra resources would be needed if every local authority performed as well on delayed discharge as the best local authority. He said:

“Even having sorted that out, if we have a widening gap between the availability of social care and the rising number of frail old people, that is going to show up as extra pressure on them, their families, carers and of course the NHS.”

Of course we want to reach a position where the best practice in tackling delays is spread throughout the country, but Ministers have to start to reflect on what their Government have done through the cuts they have inflicted on local authority budgets. Figures from the Local Government Association show that the hardest hit local authority has had cuts to its budget of 53% over the past five years; the average cut is 39%.

The budget cut for Surrey was at the lower end of the scale, at 29%. Even so, the cabinet member for social care in Surrey, Councillor Mel Few, wrote a letter to The Guardian about the issues faced by his local authority. He said:

“The Care Quality Commission is not the only organisation with worries about inadequate adult social care funding and the impact on already clogged-up hospitals.”

He went on to say that although the social care precept was

“a welcome move, it falls many millions of pounds short of what is needed now—let alone in two decades.”

I suggest that the Health Secretary and the Chancellor talk to social care leaders such as Councillor Few to understand the needs that they see in local communities and the impact of the lack of social care on NHS hospitals. Ministers have been warned and warned about the impact of cuts on social care, but they have ignored those warnings. The Royal College of Emergency Medicine has said that emergency care is

“on its knees…mainly due to a lack of investment in both social and acute health care beds”.

[Sir Nicholas Soames (Mid Sussex) (Con)]

Will the hon. Lady give way on that point?

[Barbara Keeley]

No, I will not.

The BBC has reported that last week there were 18,000 trolley waits—that is, people waiting on a trolley in a hospital corridor—of more than four hours, and there were 485 cases of patients waiting more than 12 hours. My hon. Friend the Member for Preston (Mr Hendrick) rightly said that we do not even know the figures for patients waiting in corridors, or being treated and waiting on a chair because of a lack of trolleys.

The figures do not tell us about the misery for patients and their family members waiting with them. Last night, a senior A&E consultant said on “ITV News” that patients can be left with absolutely no dignity during these waits. He said:

“We have got patients with severe illnesses on chairs receiving drips, antibiotics, medications, and patients with cardiac problems on chairs because there are no trolleys for them to go on to.”

The senior doctor talked about patients who were left unable to move off their trolleys or who were stuck on chairs and about a lack of shutters and blinds, meaning that patients can be left in full view of others while they are being treated. He also reported that some patients were incontinent in front of relatives and strangers because hospital staff could not reach them in time. He said:

“Patients have absolutely no dignity left.”

That is what the lack of social care and acute beds can lead to. How would any of us feel if that was our relative?

The situation may get worse with the expected cold weather, when more major incidents may be declared and more hospitals are put on black alert—the most severe warning level, which means that they cannot cope with the number of patients.

Downgrading the four-hour waiting time target for A&E misses the point that the problems in emergency departments are a symptom of a much wider problem. As has been discussed in the debate, that four-hour target is a proxy for patient safety. It is miserable for a sick patient to lose their dignity through being incontinent during a trolley wait in a hospital corridor. It is also miserable and frightening for a vulnerable patient to be discharged in the middle of the night to a cold home with no care package. That is why we repeat in the motion our call for the Government to bring forward £700 million of the funding promised to social care in 2019 to help the NHS and social care systems to cope with the extra pressures this winter. We are also calling for a new, improved settlement for the NHS and social care to be included in the Budget in March, so that we avoid this sort of crisis in future.

Staff in emergency departments are at the sharp end of saving lives. Many other NHS staff save lives, too, but A&E staff are so directly on the frontline. Whether they are working in people’s homes or in care or nursing homes, care staff make a huge difference to the lives of millions of older and vulnerable people, people with disabilities and people with mental health conditions. Those should be the best jobs in the UK, but without the right investment in the funding they need, the people doing them feel undervalued and overstretched. I urge Members to vote for the motion tonight.