Social Care Services

Alex Cunningham Excerpts

Tuesday 17th May 2011 Westminster Hall

[Alex Cunningham (Stockton North) (Lab)]

I look forward to serving under your chairmanship, Mr Brady. I am pleased that we have the opportunity to debate this important subject, which is being discussed more widely around the country by families and individuals who fear for their future.

The Government will try to boast that they are providing extra cash for social care, but that is not how people out there see things. “Hardest hit”—that is how the thousands of disabled people who marched in the streets outside this place last week described themselves. One woman from Billingham in my constituency, who has been blind since the age of 18, was among those who made the long trek to Westminster, and she told me about her anxieties and the effect that the cuts will have on her life. She and the other demonstrators had every right to be angry; they will be the hardest hit by the Government’s proposed cuts to disability benefits and the hardest hit by the swingeing cuts to council services that began this year, with more to come over the next three years. That means four years of anxiety and dread for families and individuals whose way of life depends on services with an uncertain future.

Last year, adult social care services helped 1.7 million adults to do things that most of us take for granted. Those 1.7 million adults remember the Chancellor speaking of his £6 billion cuts to local government grants and saying:

“Not a single penny will come from the frontline services that people depend on.”

How hollow those words ring today. I am sure the Minister intends to refer to the £1 billion that the Government are giving councils over four years to spend on social care services and to the £1 billion that doomed primary care trusts are supposed to spend on them over the same period—cash they are expected to take directly from the health budget, which the Prime Minister claims to be so protective of.

The trouble is that even the Conservative-led Local Government Association calculates that £4.6 billion is needed just to stand still and to maintain services as they are today. The reality is that the £530 million of additional funding that the Government have provided for social care in their first year is dwarfed by the £3 billion that councils have had to cut. According to the Financial Times and the Association of Directors of Adult Social Services, £1 billion of that has been cut from adult social care.

[Lilian Greenwood (Nottingham South) (Lab)]

Adult social care accounts for £1 in every £4 that my local authority in Nottingham city spends. Does my hon. Friend agree that it is inevitable that social care services will be affected when a local authority’s budget is cut by more than 16% in just one year, as Nottingham’s has been?

[Alex Cunningham]

It most certainly is. My hon. Friend says that social care accounts for £1 in every £4, and a 16% cut represents a considerable reduction in the amount available to spend on social care.

ADASS also concludes:

“savings on this scale simply cannot be achieved through doing the same things more efficiently or by trimming management costs”.

As for the money that has gone to PCTs, can the Minister tell us, hand on heart, that he has any idea how much of it will be spent on social care this year? Given the revolution unleashed by the Health and Social Care Bill, PCTs have had other issues on their mind as they have sought to protect services during a transition period that will see them abolished. More importantly, this transition period threatens to reverse the progress made on health and social care over the past few decades. I just wonder what guarantees there can be that we will have properly commissioned and funded care once PCTs have gone and have been replaced by consortia that do not have the expertise and understanding of our community’s wider health and social care needs.

Media reports just this weekend outlined the profits that some think can be made from the health and social care system, effectively taking hard cash from the front line. The Prime Minister’s senior adviser, Mark Britnell, told a New York conference attended by the giant private health care providers that dominate in north America that the changes over the next two years will provide a “big opportunity” for the profit-making sector. As I am sure hon. Members will know, no one can make profits without taking cash out of the system. I look forward to hearing what reassurance the Minister can give those who will be hardest hit. What is his guarantee that profiteers will not have their way with the NHS and related social care services?

I know that Ministers get fed up with MPs from the north highlighting the divisions in our country, but the BBC is highlighting them now. In a survey released last week, it identified a new north-south divide, with social care spending this year falling in the north while actually rising in the south, although I will question the value of that so-called rise later. The BBC’s findings reflect the differential impact of the cuts, with councils in the midlands and the north more reliant on central grants and thus hardest hit. The findings may also reflect demographic differences and the effect of falling property values on people’s ability to self-fund.

In the north, spending will fall by 4.7% in the current financial year alone. Then there are deprivation factors to be taken into consideration. Local authorities in the most deprived areas—many are in the north, but they are elsewhere as well—have the worst mortality figures and the highest incidence of long-term ill health, but they are suffering the deepest cuts in spending power. Front-loading the cuts means that huge changes must be brought in quickly, giving little time for consultation with staff and service users over the best way to minimise the impact on front-line services. That said, I would not like anyone to get the impression that things are rosy in the south. The 2.7% increase in spending in the south is about half the rate of inflation and does not keep pace with need. Nor will it be enough to prevent real people from losing real support—support that, in the Chancellor’s words, they depend on.

My main purpose in securing the debate, however, is to consider the human impact of social care cuts, not just to debate dry spending figures.

[Anne Marie Morris (Newton Abbot) (Con)]

I note what the hon. Gentleman says about funding. He briefly mentioned the issue of commissioners and quality, which is clearly as important as funding. Does he share my concern that the changing role of the Care Quality Commission, which will now monitor providers rather than commissioners, will mean that there is a gap and therefore a risk that commissioners will not be held to account and provide good-quality care?

[Alex Cunningham]

Yes, I agree that there is a considerable risk. I should say that I have been much impressed by the role played by local authorities in health scrutiny. I hope that the Minister will answer the hon. Lady’s question directly later.

The successful judicial review against Birmingham city council’s adult social care cuts looks set to be hugely significant. The Minister might be tempted to hide behind a carefully drawn veil of localism, but does he really consider it acceptable that Birmingham should seek to withdraw support from 5,000 people? Many of those people could be in a situation where abuse or neglect have occurred, or will occur, or they could be unable to carry out the majority of their personal care or domestic routines. They will be the real losers in all this.

Does the Minister consider it acceptable that 2,145 elderly and vulnerable people in Lancashire will have all care and support removed, as part of cuts that are the subject of another judicial review? Does he consider it acceptable that desperate families are being forced to go to the High Court to try to prevent devastating damage to their quality of life or that of family members?

In West Sussex, the “Don’t Cut Us Out” campaign has brought people together to campaign against eligibility cuts. If Members visit its website, they can read testimony from Tony, who has limited mobility. He must carry an oxygen cylinder wherever he goes and he is susceptible to blackouts and periods of deep depression. He will lose all the benefits and support currently provided by West Sussex county council. He says:

“My current care package...provides for 13 hours of care support each week and has kept me out of hospital for much of the last two years, saving the Country hundreds of thousands of pounds. Before, I was in hospital for six months at a time, and once discharged was being re-admitted every two weeks or so. I can’t imagine what my life will be like without this support.”

Back in the north, local people, service users and staff have been campaigning to halt the closure of Leeds crisis centre and the threat to mental health day services in Armley and Hunslet. At a packed campaign meeting organised by Unison, a campaigning trade union of which I am proud to be a member, a service user said, “I am saving the council money by using these services; when living in London, where there weren’t these services, I had many hospital admissions; I have had none since living in Leeds.”

Mencap provided me with a graphic example of what the cuts mean for George and his daughter, who are from Rotherham. George’s daughter has profound and multiple learning disabilities. Due to her disability, she is doubly incontinent and requires the use of many disposable items of medical equipment. She lives with her dad, and as part of her care package, the council picks up all body and medical waste from the household. The waste includes faeces, urine, blood and vomit. Mencap says that Rotherham council has gone from collecting the hazardous waste once a week to once every 14 days and has reduced the amount that it picks up by 50%. The council has also stopped providing specialist waste bags for the disposal of the waste, leaving the family to cover the additional cost themselves. That bodily waste now goes into black bin bags mixed with household waste, which are sent to landfill. These stories illustrate the fundamental truth: these cuts are a false economy with devastating human, social and economic costs.

In a recent national survey by a group of charities, including Carers UK and the Alzheimer’s Society, half the respondents said that increased charges for care meant that they could no longer afford essentials such as food and heating, and more than half said that their health had suffered as a result. We must consider the services run by voluntary organisations—dare I say it?, the big society—that offer early help for people who do not necessarily qualify for assessed council support. Day care centres, meals on wheels, support groups and drop-in centres are being cut because they are losing grant funding.

Jackie Dray used to run four support groups called “Elders with Attitude”—I love that name—in Birmingham, but she was told in March that her £30,000 council grant was to be cut altogether. She now runs only one group and is desperately looking for alternative funding. She said:

“They are cutting luncheon clubs or groups like mine that could make a difference between somebody remaining in the community or sinking into clinical depression and residential care. For a small amount of money, you could delay the point at which people have to go into hospital. I see a lot of clinical depression in carers and cared-for alike. People are teetering on the brink. There’s a lot of frustration, worry, lack of sleep.”

Before we can consider the future of social care services, we have to consider the consequences fully.

While we await the Dilnot commission report on long-term funding and the Government’s response to the Law Commission review, the Government are, in effect, already re-engineering the infrastructure of care and support. As services are razed, my fear is that capacity is being lost, services are being withdrawn and staff are being lost—capacity and skills that cannot easily be recreated. The Government are seeking to soften people up and lower their expectations, to get them to accept a return to reliance on family and buying from the open market with their own funds, or a patchwork of precarious charitable provision from a third sector suffering its own cuts and challenges.

I want to turn to the ideal, which I thought all the parties shared, of personalisation in adult social care. I fear that that ideal is being lost. The cuts mean that the policy, which promised much, is fatally undermined. Social workers and care managers tell their union that they are being expected to reassess personal budgets with a view to cutting them. I know that they need to consider value for money for all care packages, but they believe that they are expected to make cuts to get the budgets down.

A forthcoming report on a survey that Unison conducted with Community Care will highlight the fact that the paperwork and bureaucracy associated with personal budgets is excessive and inaccessible for service users. I question the Minister’s decision to prescribe from Whitehall that personal budgets be provided in the form of direct payments. That appears to be at odds with his claim to be a champion of local determination and removes choice from people who wish to have a managed budget. It appears to be linked to the aim of completely withdrawing state provision. Individuals will be expected to navigate the market or take on what many will see as the onerous and stressful responsibility of becoming an employer. I urge him to reconsider the prescription of direct payments, as there is evidence that it will restrict choice, but more importantly, distress some of our most vulnerable people, who already have enough challenges in life.

As we contemplate the future of adult social care services, there can be no under-estimating the scale of the challenges that we face as a society: by 2041, the number of adults with learning disabilities, we are told, will have risen by 21%; the numbers of young people with physical or sensory impairments by 17%; and disabled older people by a massive 108%. We all know that the number of dependent older people is set to increase hugely. The Association of British Insurers says that currently 20% of men and 30% of women will require long-term care at some point. If we add to that the challenges of the increasing number of young adults with complex needs who will need very expensive care packages for decades; the 170,000 people with a learning disability who Mencap tell us live with parents and carers who are already over 70 years old; the growth in the number of people with dementia, which the Alzheimer’s Society says is set to soar by a third to 1 million people by 2025; the costs facing authorities due to alcohol misuse; and the number of people with obesity-related problems, then we can see that the Government’s proposals are destined to fall well short of what is needed.

The director of children, education and social care for Stockton-on-Tees borough council, which serves people in my constituency, says that we have to be mindful of the knock-on effect of the reduction in other funding streams that impact on adults—the independent living fund, the Supporting People programme and affordable housing funding. She tells me that some of the funding streams that have historically been linked with it are being reduced or ceasing, while her department works to maximise people’s independence.

[Lilian Greenwood]

Does my hon. Friend share my concern that these cuts come alongside the cuts to disability benefits outlined in the Welfare Reform Bill, in which Ministers talk about targeting those in greatest need? Is not there a danger that disabled people with moderate needs could lose all support and face isolation and a loss of independence?

[Alex Cunningham]

That is very much the case. A stream of people have come to our surgeries or to see us in Parliament, and there seem to be so many attacks—left, right and centre—on some of the most vulnerable people in our society. As my hon. Friend says, something needs to be done if we are to arrest this situation.

The director of children, education and social care for Stockton-on-Tees borough council says that the result of the cuts, if we have limited extra care and supported living options, will be a further over-reliance on residential provision. An integrated health and social care facility and extra care scheme in Billingham in my constituency was an important part of my council’s strategy for supporting people, but the Government refused the private finance initiative credits to make it happen. Would the Minister prefer his granny, mother or other elderly relative to be forced into residential care when they could have been supported in their own home or an extra care facility and had the independence that I know most older people want?

Another area of concern is the shortfall in funding to support carers. Yes, I know that the Government allocated a welcome £400 million for carers’ breaks, but other funding managed by PCTs to support adults and their carers is not ring-fenced in any way, and although some flexibility is needed, carers, who are often seen as the poor relation, could end up all the poorer.

The sector skills body estimates that the social care work force needs to double by 2025, yet it is a sector characterised by labour shortages, low pay, poor prospects and a poor image. Some 60% of care workers hold no care qualifications, and only 20% have a national vocational qualification level 2; only 10 % have an NVQ level 3. Before anyone intervenes on that point, I should say that I believe that previous Governments, including our own Labour Government, could have done more to address that issue. However, it is not just Governments’ responsibility; other organisations, including service providers, should play their part in driving up qualification standards and meeting the costs.

Is the provision made by such organisations being properly managed or being left to the market? In Stockton, we have over-provision of residential care places, some of which are under financial pressure, including those owned by Southern Cross, which is seeking £100 million from investors to secure its future. Surely we need some kind of controlled management or strategic planning to get this right and ensure that standards are maintained.

We must look to the future of adult social care. We need immediate action to lay the groundwork for genuine reforms to flourish. The Chancellor said that his cuts would not touch front-line services; he should be prepared to say that he got it wrong. There is an urgent need for a new plan that looks again at the local government settlement and works with local authorities to ensure that front-line services are funded to meet need. Everybody agrees that we must do more to give early help because it prevents dependence and saves money on acute care, and yet those services are first in line for the chop. Will the Minister genuinely and strenuously consider the recommendation of a duty to provide early help for adult services such as that which Professor Munro made for children’s services?

The Minister must reconsider the equation of personalisation with the transaction of receiving direct payment. Personalisation is not about ticking boxes and having the right number of people receive direct payment. Trying to make it work in the context of the cuts requires him to spend time talking to practitioners and service users about what is happening on the ground and what they think the priorities should be. We need to get it right for individuals.

We need an improved and comprehensive work-force strategy covering training, development and qualification standards as a condition of provider registration and a commitment to working towards a living wage for all care workers. We must work with work-force representatives to boost the autonomy and confidence of practitioners. I am sure that the Minister will welcome, as work-force regulators have, Unison’s duty of care handbook for health and social care staff. The handbook aims to promote awareness among workers of their duty of care and other professional duties, and of how to raise concerns about poor practice.

Costs, too, need to be addressed urgently. The Association of British Insurers says that the average cost of care in residential homes in the UK is approaching £25,000 a year, with people in England spending an estimated £420 million a year on private home care. This question was not sensibly debated during the general election. We need cross-party co-operation to reach a long-term sustainable solution to the problem.

[Anne Marie Morris]

The hon. Gentleman raises a question about care homes and fees. Does he agree that one way to solve the problem would be to introduce a standard contract? At the moment, there are great differences in provision; there is no consistency in standards, which means that one person’s care can be very different from another’s.

[Alex Cunningham]

During my time I have visited many care homes, and I have seen many variations in quality and standards. I have seen some places where elderly people were highly motivated and excitedly engaged in activities and others where people were sitting in seats glued to the television—at least, I think that they were glued to the television; they certainly seemed to be in another world. I agree with the hon. Lady that we need a solution of exactly the sort that she outlines.

There is an overwhelming desire to end the postcode lottery for care. It is important that when people move around the country, they should receive the same standard of care without their cases being constantly reassessed. Recommendations made by the Law Commission for national eligibility criteria and carer assessments are a start in plotting a way forward. We must end the cost-shunting and turf wars between health and social care over continuing care assessment and funding. Do the Government still intend to allow the Law Commission to draft a Bill to simplify the legislation, and if not why not?

When Dilnot reports, we need to hear from Ministers a genuine commitment to cross-party engagement on long-term funding. The Minister must realise that a voluntary insurance market, like that described by the Prime Minister’s senior adviser this weekend, will not be acceptable to a public worried about the workings of the discredited financial services sector.

As well as a new funding system, we need to review the quality standards of service regulation, with greater emphasis being placed on the importance of providers having a stable, highly skilled and confident work force. The quality of care is all about the quality of relationships, but for as long as we have a 25% turnover of care staff we are letting down the hardest hit, who deserve much better.

The future of social care and its funding is not a matter only for this generation or this Government. We all have a responsibility. I hope that the Minister accepts that the Government should not go it alone, but should work with everyone involved to find the kind of long-term solution that will help to ease the anxieties of an increasing number of disabled and elderly people.

I end with a question for the Minister. If we are all in this together, why is it that adult social care is the hardest hit? Is it not the case that the most vulnerable are taking a disproportionate hit? I hope that the Minister will accept my points and other constructive points made during this debate, and that he will answer our specific questions. He should reflect on the unfairness of what is going on. He should realise that despite all the statements, funding is not meeting today’s needs and that current plans will not address the increased demands of the future. I hope that he will tell all those who receive adult social care services that he will make changes to current and future plans to ensure that the most vulnerable have a quality of life that most of us take for granted.

--- Later in debate ---

[Mr David Anderson (Blaydon) (Lab)]

It is a pleasure to be serving under your chairmanship, Mr Brady. I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing this debate, which is timely not just because of the demonstrations that we saw outside this place last week, but because we are in the pause before the Health and Social Care Bill comes back to Parliament. This debate is also a matter of great personal passion. In 1989, thanks to the behaviour of a previous Tory Government, I lost my job in the coal industry and had to take up a job in care. Although I ended up in that sector almost by mistake, it was one of the best things that ever happened to me. I met some fantastic people who were dedicated to taking care of the frail and vulnerable people in the city that my hon. Friend represents. Sadly, in the early 1990s, a lot of that care, commitment and dedication was lost. A series of cuts from the national Government decimated the care services across the whole country, and we see the same happening today.

I hope that the Health and Social Care Bill will be withdrawn in its entirety. Despite what they say, it is clear that the Government are leading us to a privatised NHS. The experience of social care should show us what happens when we put services out to the private sector. We are told that the White Paper has been delayed. There may be some last-minute qualms from the Government about how far they can go against public and professional opinion. I am surprised that the pause has happened now, because public and professional opinion has always been against this Bill, even when it was first announced. Perhaps that opinion took a while to sink into the minds of the Government; it certainly did not immediately sink into the minds of the Liberal Democrat members. It clearly has now, and thank God for that. I hope that the Minister, along with his colleagues in his party, will work with other people across society to ensure that the Bill does not go any further and that we do not see the same damage to the health service that we have seen to the social care services.

Research carried out by Unison suggests that, if recent trends continue, the last council-run residential care homes will have closed in 15 years’ time and there will be no local authority-employed home care staff left by 2020. That is part and parcel of this Government’s drive not just to boost the private sector but to deconstruct public sector provision and give councils less and less responsibility. The anti-public sector phalanx in the Cabinet will, I am sure, be happy to see that happen and it will celebrate the disappearance of council-run services. It will argue that the private sector always performs better, despite the fact that that has not been shown to be the case.

[Alex Cunningham]

My hon. Friend is talking specifically about local authority provision of care homes. Is it not more important that we invest in extra care facilities and that we work with elderly people so that they can live in their own homes, because that is what the vast majority of them want to do?

[Mr Anderson]

I agree with my hon. Friend. My own personal experience was in a purpose-built site that did just that. We took in people for a week at a time for respite and we also provided day care, but the individuals all lived in their own homes. Although that was cost-intensive in labour terms, the quality of care was good. We took care of not just the individual but the needs of the family, and we built very close working relationships with them. If we want to have quality care in this country, we must bite the bullet and accept the fact that we have to pay for it. The previous Government accepted that if we wanted quality health care, we had to increase the public payment into it.

--- Later in debate ---

[The Minister of State, Department of Health (Paul Burstow)]

It is a pleasure to serve under your chairmanship, Mr Brady. I congratulate the hon. Member for Stockton North (Alex Cunningham) on his luck in securing the debate and on his choice of subject.

I agree with the hon. Member for Islington South and Finsbury (Emily Thornberry) on one point at least, which is that social care is not debated and discussed in this House anywhere near enough. I speak with the experience of 13 years in opposition and as one of the few who has carried the candle for social care and advanced the arguments, which I have heard others make today, on the need to focus on quality and to make sure that we do well by and develop the work force. I shall return to some of those points.

I agree that the long-term reform of our social care system should no longer be deferred to the long term. It requires our full attention now. We need to make sure that, during the life of this Parliament and, I hope, with the assistance of people of good will from all sides, we can secure lasting reform of both the law and the funding arrangements for social care. Our constituents expect no less of us at this time.

The hon. Member for Stockton North began by referring to last week’s march and lobby. A number of constituents lobbied me, and I met several of them at my surgery last weekend to discuss their issues. They have real concerns, to which the Government are listening and want to respond properly. We share a common goal, which is to maximise personal independence to allow people of all abilities to fulfil their potential. That has to be the common goal of both our benefits system and our social care system. It is certainly this Government’s ambition to achieve that.

I do not belittle in any way, shape or form the stories of the lives of individuals and the impacts of decisions made about spending in different parts of the country. The hon. Gentleman has rightly set out those individual and personal impacts. However, I will offer him a reflection on the past 13 years and, indeed, before that. The stories that he has told could have been told and have been told over the past 13 years, during which time we have seen a gradual tightening of eligibility criteria. Indeed, in 2008 the Learning Disability Coalition published a survey that showed that 72% of what were Labour authorities at that time anticipated—indeed, they were budgeting for this—tightening their eligibility criteria for access to services from “moderate” need to “substantial” need or even to “critical” need. I will discuss the reality in a moment.

Although the hon. Gentleman has rehearsed some important points, what I did not hear was a scintilla of humility, a suggestion of any doubt, or a slight recognition that we are where we are at least in part because of actions taken over the past 13 years. It would have been good to hear just a little indication that we are where we are because of what has already happened.

[Alex Cunningham]

Will the Minister give way?

[Paul Burstow]

In a moment. If the hon. Gentleman will let me make my point, I will be happy for him to attempt to rebut it. There are things that did not happen over the past 13 years. We did not get to a position where we had a clear statutory basis for adult safeguarding. We did not get to a position where we had consistency of regulation, because the regulator was constantly being abolished and reformed. Funding has been inadequate for many years, and we have seen a failure, for various reasons over 13 years, to find a way forward that has secured consent for funding.

[Alex Cunningham]

The Minister said that I did not show any humility, but I specifically said that the previous Government and others before them could have done much more on social care. I specifically said that, and it is important that that remains on the record. In the past 20 or 30 years, no Government have addressed the fact that so many more older people and so many more young disabled people will require tremendous support. I hope that the Minister will acknowledge that we all need to do this together.

[Paul Burstow]

Yes; we can build on that point. The Government recognise the importance of social care and the fact that it lets people live independently, which is what it should be about. It should be about enabling people to live well, to be safe, to continue to do things that we take for granted and to be active participants in civic life.

As has been rehearsed in this debate, there are big challenges. There are demographic challenges and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) has outlined some of those facts. The hon. Member for Wolverhampton North East (Emma Reynolds) has rightly said that, while we should be concerned about the challenge, we should not be so concerned as to forget to celebrate the fact that we have an ageing population—a population that is living for longer and, in many cases, living healthily for longer as well. We also have changing societal expectations and a greater expectation of being able to make choices for oneself, to be in control of one’s own life and to be able to have high standards of support to facilitate that. We have financial challenges. We have a structural deficit. For every £4 that this Government spend today, £1 is borrowed, and we are spending £120 million every day on interest charges.

Reference has been made to the survey by the Chartered Institute of Public Finance and Accountancy for the BBC. I have to say that, of the many surveys that have been produced, including that of the hon. Member for Islington South and Finsbury, it is probably the least robust of the lot. There we go—I give the hon. Lady credit that her survey must be more robust than that of CIPFA, which did not provide a great deal of detail and did not ask the right questions. Indeed, those who answered the questions were not all social services authorities, and they included things in their figures that are not part of social care. Even the Association of Directors of Adult Social Services has criticised that piece of work.

On attempting to address and mitigate the impact of the reductions that the Government have had to make in formula grant over the past year, we have strived to mitigate it in those areas with the greatest needs to make sure that we have increased the support in those areas, relative to others.

The hon. Member for Stockton North talked about high mortality figures in constituencies such as his own. Again, we have to dwell on why that is still the case after so many years, why we still have that legacy, why we have to continue to address those challenges, and why this Government, through their commitments in public health and elsewhere, are determined to make progress.

Despite the deficit legacy, we have taken some decisions. Members have forecast that I would refer to them, and I make no apology for that. We set out in the spending review in October how we would ensure sufficient resource in the system to allow decision makers at a local authority level to protect social care, if they decide that that is their priority. We have a good settlement in that context. An additional £2 billion will come to social care by 2014-15, and that money is getting through. In January, £162 million was put into social care via the national health service, which is something that we were asked to do and which we have done to ensure that social care gets additional support. Moreover, there is £648 million of additional funding from April this year. That money is going to social services departments and is being transferred by the NHS for that very purpose. A further £1.3 billion is supporting the transfer of funding for the commissioning of learning disabilities.

Those sums constitute the biggest transfer of hard cash from the NHS to social care ever. It is not only about supporting social care, but about breaking out of silos. It is about using cash to get people to start having those dialogues that are so important to achieve the collaborative behaviour and integration that are essential to delivering better services for our citizens.

On top of that is the £530 million that will come through the formula grant. I will not micro-manage, from this Chamber or my desk in Whitehall, every single social services authority and tell them how to use that money. It must be their decision, based on need, and they are accountable for such decisions.