Health

Anne Marie Morris Excerpts

Monday 9th June 2014 Commons Chamber

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

The Gracious Speech was an extremely fine speech, but I would have liked more work on the care agenda. The Care Act 2014 made a very good start, but there is more to be done. This concerns me particularly because Devon has the highest number of over-65s in the country, and my constituency has a very large chunk of that population.

By 2035, 25% of the population will be over 65, 620,000 will be in care homes, 50% will have a sight impediment, and 75% will have a hearing impediment. Today, one in five over-80s has dementia, and that figure is set to double within the next 30 years. The demand is not going to diminish, while the supply is a real challenge for our society as a whole. Seventy-five per cent. of current need is met informally through the voluntary sector and by families. We must give thanks for that, but we then need to think about the financial contribution from the state. The NHS budget, which is now 8.4% of GDP, is in absolutely the right place—that is exactly what we should be spending given the current state of our finances—but the social care budget is decreasing and has decreased by 10% in real terms since 2010, if Age UK’s figures are correct. The reason is cuts in council funding. In my rural constituency, council budgets have been seriously hit, and I see the consequences day in, day out. Day centres in Devon are facing closure and support for supported living is being ripped out. This is a matter of great concern that must be addressed quickly.

I welcome the 2015-16 better care fund of £3.8 billion, but will it be enough and will it be too late? Age UK says that £3.41 billion more is required if we are really to meet the need. I am a great believer that we do not solve everybody’s problems through money, so we must look at what we need to do. There is nothing more important than health and dignity in the ageing population. We need to look at what we, in a civilised society, believe good care should look like. We need a proper debate about who pays. Is it the individual, their family, or the taxpayer? We need to look at who delivers it. Is it the family, the voluntary sector, or the state? Clearly, it must be all those.

The Care Act made a good start. It provided uniformity in the funding structure, consolidated the assessment process, capped costs, recognised carers and the need for support, put a duty on local authorities for care and well-being of our older population, introduced safeguarding adult boards and the star rating system—very good steps forward—and recognised that prevention is better than cure. In some ways, however, it was a missed opportunity. The commissioning process that decides what is ultimately purchased is not overseen. We still have a postcode lottery against which people’s only recourse is an individual appeal. We still have a conflict of interest in that our councils can commission and provide care, as many do. That has to change. On quality, star ratings are a good move. Let us remember that this is about relativity, not absolute quality. What are we paying for—brass or platinum? There is, as yet, no reassurance that wherever anybody lives they will get the fair share of care that they deserve.

Staffing issues were not addressed. Best practice as regards staff and patient numbers is a ratio of 1:5, but the reality is more likely to be 1:7 given the budgetary constraints. No thought was given to trying to deal with some of the training concerns. Skills for Care is a voluntary programme. If we are going to make something really work, there has to be some stick and some carrot. I am pleased that we have a studio school in Torquay that meets some of the training needs and that the University of Surrey will introduce a proper foundation degree in 2015, but more is needed.

Integration could have been addressed. This is not just about money; it is also about health and wellbeing boards. The King’s Fund suggested that there should be a requirement that providers are engaged in health and wellbeing boards. At the moment, only 30% are so engaged, and that needs to change. I am very pleased that in Newton Abbot we have a pilot on the frail and elderly that deals specifically with integration.

There has been a missed opportunity for change, and change must come soon. We need to think about how to fund smartly. How can we increase the amount available to councils? After all, prevention is better than cure; otherwise A and Es and the NHS pay the price. How can we better support families to care for their elderly as we help them to care for their children? What can we possibly do in terms of time, flexibility and tax support? How can we support the voluntary sector? There is not an inexhaustible supply of volunteers, and they are fed up with the form filling that makes their lives burdensome. How can we reduce the capital burdens that councils face when having to deal with providing care? The capital cost of the homes and day centres is driving the closures. Let us work with social enterprise, housing associations and others to look for a better model.

Let us improve quality and remove the postcode lottery. Let us, as we can under the Care Act, ask the Care Quality Commission to review the whole commissioning process. Let us look at what is provided by our county councils, what value for money we get, and whether it is the same across the country. What are we paying for? Are we finding that people in one county are getting bronze and those in another, where more money is allocated, are getting platinum? That cannot be right. Let us look, once and for all, at splitting purchasers from providers as we have in the NHS. Let us get rid of the potential bias that exists in this regard. Let us review the make-up of health and wellbeing boards and make sure that providers serve on them.

Without proper resource, and that means people, we cannot get this right. We need to ensure that more nurses are trained and that they get the respect and the pay that makes them want to work in social care as much as they want to work in the NHS. Let us produce a proper career path that drives respect and reduces the fear they live in that they are going to be criticised for trying to do their best in an impossible situation. Let us enforce the best practice ratio of 1:5. Let us look at how we are going to fill the gap whereby unless one gets to a level of substantial need one will not be funded by the state. There is so much to be done and so little time. This has to be a priority for Government this year.