Care Homes: England

Alistair Burt Excerpts

Wednesday 13th January 2016 Westminster Hall

[Peter Kyle]

I am extremely grateful for that intervention. I had not considered that and I will take it on board. I am grateful to the hon. Gentleman for pointing it out and putting it on the record.

It may not be a Southern Cross that fails first. In fact, it is most likely to be the smaller, independent providers in areas that are most dependent on local authority placements. Can the Minister reassure us that his Department and local government have the capacity to respond to any piecemeal closures that are likely to occur?

[The Minister for Community and Social Care (Alistair Burt)]

indicated assent.

[Peter Kyle]

The Minister is nodding and I look forward to testing the argument in his statement.

Everyone here wants to ensure dignity for all later in life. That can be assured only if there is a properly resourced residential care sector with stability and financial security. I look forward to hearing the Minister’s response and receiving reassurances that all Members, of whatever party, want to hear, and I look forward to being able to work with him and care home providers in the months and years ahead to ensure that that type of residential care sector becomes a reality.

Mrs Anne Main (in the Chair): I shall call the Scottish National party’s Front-Bench spokesman at 3.30 and then the Opposition Front-Bench spokesman and the Minister. Quite a few hon. Members want to catch my eye and if they divvy up the time between them that will be helpful.

--- Later in debate ---

[The Minister for Community and Social Care (Alistair Burt)]

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate the hon. Member for Hove (Peter Kyle) on securing the debate and thank him for introducing it courteously and knowledgeably. He is a valuable addition to the House, as indeed are a number of the new Members who have spoken. This is another example of a debate where the House’s knowledge and passion is conveyed in an entirely reasonable but challenging manner. I do not think this is the only debate we will have on this subject, so we will return to a number of issues.

I thank colleagues for their contributions. My hon. Friend the Member for Bexhill and Battle (Huw Merriman) spoke about the quality care provided in our care homes, and it is important not to lose sight of that. The right hon. Member for Enfield North (Joan Ryan) spoke about costs—we will come back to that—and workforce issues. The hon. Member for Rochdale (Simon Danczuk) spoke about the need to ensure that local authorities in poorer areas are covered, and I will speak about that. The hon. Member for York Central (Rachael Maskell) spoke about choices, and I will come back to her on that in a moment.

The hon. Member for Redcar (Anna Turley) spoke knowledgeably about workforce issues. The hon. Member for North Ayrshire and Arran (Patricia Gibson)—we wish her mother-in-law well in the home where she is situated—gave more examples of what is happening in Scotland. I am always keen to see whether we can find anything that can be extrapolated from what is done up there. The hon. Member for Worsley and Eccles South (Barbara Keeley) spoke with her usual eloquence and from her strong background in the subject. Again, we will be covering a number of these issues over quite some time, and it cannot be completed today. I thank colleagues from all parties who made interventions.

I will not be able to respond to every point in 10 minutes. I will talk about quality and care issues, the spending issue and contingency—what to do if there is a problem. I think those are the three biggest things. That does not mean that I am uninterested in integration and winter pressures, which we believe we are working through and tackling. I will not talk much about the workforce, but I entirely agree that we should value the workforce at all levels and provide a decent career path. I agree entirely with the view that everyone has to be valued in a way that has not really been the case in social care up to now.

There are a number of other issues that I will just not be able to touch on. If there were specific questions directed at me and I do not cover them, I will go through them and write to the appropriate Member.

In general, we all start from a common position on the importance of this issue and the context in which it is set: an ageing population; people living longer with multiple long-term conditions; and many of our care workers working with dedication, both in homes small and large and in domiciliary care. I praise Chris Ryan of Bedford, who does much the same job as the gentleman the hon. Member for Hove mentioned in looking after a smaller home. It is a family business with a great sense of care and compassion, and I see those things in many homes.

May I start with a few words about quality? I am conscious of time, and I will try to keep my remarks on the three main issues that I want to cover quite short. In a way, we cannot win with the inspection regime. If inspection is done thoroughly and reveals things that need to be changed and improved, I can be lambasted for things that are inadequate. On the other hand, if we do not have a regime that turns up the things that need to be changed, then we are missing things.

The tougher inspection regime and the work that the Care Quality Commission is doing are good for us all. The bulk of homes—60% of the homes inspected, and a third of all homes have been inspected—have been rated “good” or “outstanding”. The CQC started with some local knowledge and wanted to go to the most difficult homes first. When it goes back to them it sees improvement, because the job of inspecting is not just about closing people down; it is also about seeing what improvement needs to be made.

In many cases, care is not about resource per se. I will never stand here as Minister and say that money and resource do not matter, but I will always say that making sure there is good-quality care is about many other things as well. There is tremendous variability of provision. There are people who handle the same resource in very different ways, and some are poorer at it than others. Quality of management, quality of leadership and in particular the use of registered managers in homes are all important issues, and there is much that can be learned through the inspection regime.

It is important for us to set out the five key questions, so that we remember what the regime is intended do. These questions are asked of each service that is inspected: is it safe, is it caring, is it effective, is it responsive, and is it well led? All inspections deliver a rating for the answers to each of those five key questions, on a scale that ranges from “inadequate” to “requires improvement” to “good” and “outstanding”. It is right that we do that, and I am not afraid of the answers that have been produced.

However, I want to go slightly beyond that process. I am never content to rest on what the inspection regime is bringing forward; I listen to other voices as well. Although I do not respond to all the tweets I receive, I read them all, and I am in contact with some of those who represent families and with those who have uncovered things and who do not feel that the inspection regime is doing its job. I say to them that we can do more, and I am listening carefully. I want to use the experiences of those who have been through poor circumstances to see whether we can make any changes that will make such circumstances less likely. There will never be nil bad circumstances, although there should be, but we must do all we can, and I am listening carefully to some less heard voices to try to ensure that that is the case.

I will speak about spending, which I know is at the heart of this debate, before I cover contingency. The hon. Member for York Central spoke about choices. I will not labour this point, but it needs to be said, because it is at the heart of all we do—yes, there are choices to be made. In a different context, I hear much talk about “mandate” from Opposition Members. The Government also have a mandate, and it is a difficult one. It is to try to ensure that our spending on public services matches the needs of the population and also looks after the future, ensuring that we are not running a continuous debt and running into more debt. It is a difficult choice, and we put it to the people and they gave their answer. We are working with that mandate.

The hon. Lady also said that how a society treats its old people is a measure of the quality of that society. That is quite true, as it is of our treatment of our children, those with mental health issues and our prisoners. It is also true of how we treat the future and what we leave for the future. That is why this Government, like every previous Government who have had to make difficult choices, including Labour Governments, have never been able to spend as much money as some would have wished. That is at the heart of this debate as well. We will do what we can with what we have got, and I will explain how we will do it, but that is the difficult choice that we have to make, and the hon. Lady does not have to do so yet. All I will say is that I will explain what we are trying to do in making that choice.

[Peter Kyle]

I am grateful to the Minister for giving way, and for letting us know that he reads all the tweets he receives, because that has opened up another avenue for communicating with him; he may well regret that, even by the end of today.

Part of the Minister’s mandate is to reduce spending—we understand that—and part of his mandate is to spend money better, which is an issue that has come up time and time again in this debate. There was cross-party support for an independent evaluation of the better care fund and how it applies to the care home industry. May I specifically ask him whether he will support the call for that evaluation, which came from Government Members as well as from Labour Members?

[Alistair Burt]

We are constantly evaluating the better care fund. We work on it with local authorities on a regular basis, and with the Association of Directors of Adult Social Services, so it is constantly being evaluated. I do not know whether something else would add to that process.

[Barbara Keeley]

I have made the point about choices to the Chancellor in the past. Perhaps the Minister has not got the Chancellor on side yet; I hope that he will do so. However, the inheritance tax giveaway that this Government have enacted will cost £1 billion by 2020. How far would that £1 billion go in social care? A long way.

[Alistair Burt]

We could all pick items of Government spending that we do not particularly fancy and say, “Oh, if only it was applied to this, it would be great.” Every single Government and every single Chancellor have faced the same argument. We are where we are. We have made choices about a whole variety of things, and we have a range of obligations to deliver to the public. In this particular instance, however, I want to talk about what we are spending and what is new. I will do so briefly, but I must cover that.

The Government are giving local authorities access to up to £3.5 billion of new support for social care in 2019-20. We believe that the precept could raise up to £2 billion a year, and with that money and the £1.5 billion that was included in the spending review, we believe that by 2019-20 there will be the opportunity for a real-terms increase in spending on social care.

[Barbara Keeley]

Will the Minister give way?

[Alistair Burt]

No. I have only three minutes. If I give way, I will not be able to cover everything now.

[Barbara Keeley]

I just want the Minister to say how councils such as the Essex council that wrote to the Prime Minister will manage until 2019.

[Alistair Burt]

I will give two responses to that and talk about the equalisation of funding. First, we are working closely with local authorities and with ADASS. I do not pretend in any way that the situation will not be tough for the next couple of years; it will be. However, we believe the resource is there. Secondly, the social care precept will come in this year, and that money will be made available more quickly. It will be difficult and it will be tight, but a lot of changes are being made and a lot of work is being done to ensure that services are more efficient. Those things are going on all the time.

I want to address the problem that was raised about the precept and explain how it will be used to ensure that local authorities do not miss out. The Department for Communities and Local Government published for consultation a provisional local government finance settlement in December. Recognising that local authorities have varying capacity to raise council tax, it is proposed that the additional funding for the better care fund that will be available from 2017 should be allocated using a methodology that provides greater funding to authorities that benefit less than others from additional council tax flexibility for social care. That will include consideration of the main resources available to local authorities, including council tax and business rates.

[Peter Kyle]

Will the Minister give way?

[Alistair Burt]

No, if the hon. Gentleman will forgive me; I have 90 seconds left.

That is how there will be some degree of equalisation, to respond to the point made by the hon. Member for Rochdale. More money is being spent, and there is an equalisation process.

I will speak about contingency plans briefly. Local authorities now have a responsibility, through the Care Act 2014, to monitor the care providers in their area for any early warning of difficulties. In total, 44 care providers are included. Local councils are also under a duty to provide contingency plans for what would happen if there was a failure of provision, and 95% of local authority areas are currently covered by such contingency plans. Of course, I am looking for answers from the other 5% to ensure that coverage is there. If there is a failure of provision, local authorities have a responsibility to step in, and we are addressing the situation to ensure that contingency provision is in place.

We believe that we have put in money that will assist the system and provide the care that is needed. With local authorities, we are constantly looking at what can be done to make things more efficient. We want to ensure that money is spent properly. That is why the social care precept is there; it can only be spent on social care. I have mentioned the position of councils that might be in particular difficulties over that issue, and over time, we will see whether that provision is sufficient. The Government and I will keep this issue under constant review, and we will talk about it again—

Motion lapsed (Standing Order No. 10(6)).