Adult Social Care

Baroness Keeley Excerpts

Thursday 8th March 2012 Commons Chamber

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

May I start by congratulating the hon. Member for Truro and Falmouth (Sarah Newton) on leading the debate and on the way in which she has just opened it? It is good to work with her on the all-party group on social care. In debates such as this we work together to ensure that social care receives the focus that it needs to have in the House.

I want to discuss two aspects of the future of social care. The first is the current crisis in care and the need to bring in extra resources to close the funding gap. The second is the recommendations of the Dilnot report, which the hon. Lady has already touched on, which mainly focused on dealing with the catastrophic cost of sustained high-level care and support.

On the funding gap, the Minister told me and the Health Select Committee recently:

“We don’t accept the position that there is a gap. We have closed that gap in the spending review.”

However, Age UK’s “Care in Crisis” report says:

“This year spending on older people’s social care in England has fallen by £500 million and the funding gap is growing. … We project that by 2011-13 the Government would need to spend £1 billion more than this year to stop the situation getting any worse. … The current system is at breaking point.”

Research by Age UK showed that 82% of local authorities now provides care only to those with substantial or critical needs. Fewer than one in five local councils still provide care for those with moderate needs. I have to say I am happy that that includes my own local authority of Salford.

The Economic and Social Research Council centre for population change has looked at the issue of unmet need for social care. It concludes that, regardless of the data source used,

“there is significant unmet need for care among older people.”

For example, 66% of people aged over 65 who need help with bathing were not receiving any support. That figure was based on data from 2008 and since then we have had front-loaded cuts to local authority budgets. I am sure that, although there is no up-to-date estimate, there are greater levels of unmet need than the figure I have given.

The Association of Directors of Adult Social Services has reported £1 billion of cuts to adult social care budgets in 2010-11, with further cuts predicted for next year.

This week many of us were involved when about 1,000 campaigners and 60 organisations lobbied Parliament for the urgent reform of social care and an end to the care crisis. For the first time, thousands more who could not attend Parliament joined the lobby online. A statement from those care and support organisations to MPs and Ministers said:

“Our social care system is broken. It cannot cope with a rapidly ageing population and positive impact of people living longer with illness and disability. Those who use our social care system can no longer tolerate a social care system which leaves many with no support and others with poor quality services. The public are angry that they can face huge care charges and end up losing all their savings or being forced to sell their home.”

One of the 1,000 people who came to Parliament to lobby MPs was a deaf-blind woman from Manchester who got up at 5 am to travel down because she said she was so worried about the future of social care. The Care and Support Alliance said that MPs heard personal experiences from people who need care but are receiving none, disabled people unable to access the support needed to live independently, families paying huge bills for care and carers pushed to breaking point.

I wanted to test the situation in my local area before the debate. Over the past few days I checked with three organisations that support older people and carers in Salford and the neighbouring area in Greater Manchester. This drew a depressing but familiar picture of services worsening, mainly due to budget cuts, but also due to cuts and organisational changes brought about by the NHS reforms. A staff member at Parkinson’s UK in Greater Manchester told me about her clients, people who have worked hard all their lives but are now struggling to pay for services that are essential to them. In some cases she had to apply for grants to help people with Parkinson’s buy a profiling bed or even pay off debts.

The staff member told me about a couple struggling to pay for the care needed by the husband, who has Parkinson’s. To help get him out of bed and dressed costs £22 an hour, and having someone sit with him while his wife does the shopping costs £11 an hour. Another carer of someone with Parkinson’s and dementia had her respite care cut from two weeks a year to one week. She feels that she cannot cope without those two weeks of respite. The staff member also told me that budget cuts mean that people with Parkinson’s can wait for a year for a stair lift, and she knows one man who has to go to bed at 7 pm because later in the evening his mobility gets worse and he cannot manage the stairs.

The staff member also told me that NHS efficiency targets mean that GPs are switching to cheaper brands of drugs for patients with Parkinson’s, but many of these are less effective. One person she told me about was admitted to hospital after becoming ill following a switch to a cheaper, less-effective medicine. The hospital staff had told her to “be firm with her GP” and insist on the more expensive brand. We have to be realistic that that is a difficult thing to do. NHS budget cuts in the local area have meant the loss of the community matron service, a service that was used by Parkinson’s UK staff for many of their clients but has now ended. In Salford—I have raised this point before—the primary care trust ended the pilot of active case management for people with long-term conditions, which was proving popular and effective.

Locally, Age Concern has told me that it has now lost the funding for a “Friends for Life” pilot scheme, which was part of the national dementia strategy. Its dementia support service has a planned income reduction of 40% over three years. It has had to make seven staff redundant and reduce its dementia support. Funding for day centres is being reduced by one fifth and will then be ended owing to the switch to direct payments from individual budgets. We all support personalisation and individual budgets, but not if it is a cover for cuts. I was disturbed to hear of a couple of cases where that is happening. In one case I was told about, a carer who had previously had two hours of respite care was given a budget of £9 and told, “Do what you want with the money.”

Our carers’ centre manager in Salford told me of her own experience of such cuts, this time to the personal budget of a family member she cares for with a learning disability who lives in Sheffield. Following what she described as a “fairly perfunctory” re-assessment that was done solely with the person with the learning disability, with no input from a carer or guardian—that is an important point—the personal budget was cut by £10,000. In that case, the carers’ centre manager was able to lodge a complaint and get legal help from a community care lawyer, but she knows that such an intervention would not be possible for other carers. These examples are what we mean when we talk about a care system in crisis.

However, those are not the worst examples. As I mentioned earlier, we know that some 800,000 older people are left without basic care. They have been described as

“lonely, isolated and at risk”.

Those are the words of 60 experts in social care in their recent letter asking the Government to make social care reform a top priority. We therefore know that the problem of unmet need is getting worse. Much of the additional burden will fall on unpaid family carers, many of whom are already overburdened. Statistics from the NHS Information Centre show that the proportion of carers providing more than 50 hours a week has doubled in the past 10 years. I think that that is the level at which it can be counted as a 24/7 caring job, as was discussed by the hon. Member for Brentford and Isleworth (Mary Macleod).

Many organisations have sent us briefings for this debate. There is a consistent call for a solution to the care crisis. Carers UK calls for the capped costs model that the hon. Member for Truro and Falmouth talked about. It sees a cap on costs as essential. It favours the cap being set at £35,000, which it feels would give carers and families the ability to plan for care arrangements and costs, and provide an opportunity for the development of care insurance products. I agree with that assessment and would caution against setting the cap at a higher level, such as £60,000, which has been discussed in the media. That is the value of some properties in Salford, so it could mean a family losing the entire value of their home, which would be wrong.

Carers UK believes that if families know that costs will be capped, they might be more willing to buy care and support earlier. That would help to promote independence and reduce the pressure on carers, which can result in ill health, giving up work or reducing working hours. It is thought that it will be harder to produce that shift in behaviour and move towards a new market in insurance products without a capped costs model.

Care and Support Alliance members argue for an additional £5 billion to be put aside over the next three years to meet the growing demand for social care. The cases that I have mentioned show that there is a clear need for additional resources to meet the growing demand, address the unmet need and tackle the shortfall in resources that has been growing for some years.

The Dilnot commission was given the task of making recommendations on how to achieve an affordable and sustainable funding system for care and support. Its report confirmed what has been said repeatedly for years: the current system is unfair and unsustainable, and without reform it will deliver ever-poorer outcomes for individuals and families. That includes the 1,000 people we saw here this week. The report also said that the funding of social care is inadequate and that people are not receiving the care and support that they need.

Although we may not have time to discuss this today—I certainly will not—the provision of advice and information is poor and very limited. People struggle to find financial information and advice, and there is little information and advice for carers. Worst of all—perhaps we can understand this—because the system is complex and difficult to understand, most people do not plan for, or even think about, the future care provision that they may need.

There is much consensus around the capped costs model. There is support for setting a cap at £35,000 and, as the hon. Member for Truro and Falmouth mentioned, for setting an asset threshold for means-tested support at £100,000. There are other important aspects, such as the need for national eligibility criteria and the need for local authorities to meet the eligible needs of carers. I think that those points are equally important. What still needs to be discussed, and I am not sure whether we will get into it today, is how to pay for the capped costs model and the additional resources that are needed to close the funding gap.

Care and Support Alliance members believe that there is a public appetite for reform. I think that we must take the debate across the country and ensure that the issues and solutions that I have talked about start to be debated. I have spoken about social care issues for the past seven years and I believe that they are now well understood. The 60 organisations that have lobbied Parliament this week have been lobbying on these issues for many years. The people in those organisations and the people they represent are tired of being consulted on the future of social care. What they want is action.

[Andrew George (St Ives) (LD)]

I congratulate my colleague on the Health Committee on her contribution to the report on social care. Does she agree that underlying the issue of care in crisis is an issue with the work force, who often work on the minimum income, are poorly regarded and are subjected to a lot of unfavourable reporting in the press? Does she think that we take them for granted when we look at the overall sector?

[Barbara Keeley]

Indeed, the work force issues are very important. I will not have time to discuss them today, but perhaps other Members will. The things that we hear about, such as tasks being reduced to one-minute periods and visits being cut down to very short periods, must make it a distressing and difficult job. We also have to recognise that personalisation leads to people working in an isolated way. Whereas before they might have been part of a local authority work force, they are now individually employed by care agencies and may not see anyone else. There are some new issues for us to consider, including the one that the hon. Gentleman mentions.

In 2009, after much consultation, my party brought forward plans to establish a national care service. As my right hon. Friend the shadow Secretary of State knows, Labour’s proposals for funding social care were treated as a political football, and there were some regrettable political attacks on them during the general election. That was unfortunate, and we cannot allow it to continue. I congratulate him on going back into the cross-party talks with great willingness, which must have been difficult knowing what happened to him during the election. We must work to achieve consensus across parties and across the country, because the issues that I have mentioned are becoming more pressing than ever before.

I believe I have found a unique way to link two speeches today, both of which you have heard, Madam Deputy Speaker. I talked earlier about women in sport, and this Sunday I will be running in a 10 km race to raise funds for Age UK’s “Spread the Warmth” campaign, which is aimed at making life better for older people in winter and avoiding needless deaths from the cold.

--- Later in debate ---

[Paul Burstow]

I am most certainly aware of that. Social isolation is a huge burden on the individuals affected by it and has huge consequences for health care. That is why, when I talk about independence, I also mean interdependence—the recognition of the value of family support and carers, and of the fact that people need to be active in their community throughout their life. Social care has a role to play in enabling people to do just that, rather than become institutionalised in their own home or a care home. I absolutely agree with the hon. Gentleman about that.

The Dilnot commission made a number of recommendations on the development of a system such as I mentioned, and my hon. Friend the Member for Truro and Falmouth described them well. In the spending review, we allocated an additional £2 billion by 2014-15 —£7.2 billion over the spending review period as a whole. In November 2010, we also set out our vision for social care reform, including the roll-out of personal budgets and greater personalisation. I agree that we need to ensure that that is genuinely about how we enrich people’s lives, not just an opportunity to reduce the available resources to individuals. We are also investing £400 million over four years to help to give carers much needed breaks. We are ensuring that the NHS is held firmly to account for delivering the money in the coming year by making sure that it has to account directly to carers’ organisations locally, and agree with local authorities the plans to provide breaks, spell out how many there will be and the size of the budget for that purpose.

It is also important to dispel a myth about social care, which has been hanging around for far too long—that, in some way, it is just like the NHS and free. As my hon. Friend the Member for Truro and Falmouth said, it is not free and never has been. If people assume that the state will pick up the bill, they are unlikely to prepare themselves. If they do not prepare and they need help, the impact can be truly devastating for them and their families: life savings wiped out, family homes full of memories sold off, and thoughts of a comfortable retirement turned to dust.

We therefore recognise the problem, which is getting worse. Our population is ageing, and that should be a cause for celebration. Too often, debates about ageing in our media are couched in terms of demographic time bombs and the like. However, the current care and support system is not fit for purpose. I agree with the Care and Support Alliance about that. It is broken, and patching and mending it is no longer acceptable.

However, reforming social care will not be easy. As has been said, it will require bold thinking and difficult decisions. The Dilnot commission shed much needed light on the reality of social care funding. Soon, we will publish a White Paper and a progress report setting out our response to the recommendations.

[Barbara Keeley]

Perhaps the Minister will enlighten us on what is meant by “spring”. There is speculation that spring might extend to May, June or July. When I was in government, I spent a lot of time answering questions about what spring meant in relation to Government reports. Will he tell us what it means now?

[Paul Burstow]

On that basis, the hon. Lady knows the answer that I would give and I shall therefore not tire her by saying what she would have said if she were in my place. We are anxious to publish a White Paper as soon as we can in a way that ensures that we have successful dialogue with the Opposition on funding. Those two matters are interdependent.

We are considering not just funding reform, but the legal structure that governs social care, which must be updated. The Law Commission has done a sterling job of making recommendations for replacing the patchwork that has built up in the past 60 years with a legal framework fit for the 21st century. A new social care law will bring clarity where today there is a complicated and confusing system, facilitate personalisation and support staff, service users and carers.

Beyond that, we need high-quality, integrated care, which focuses on early intervention, prevention and the needs of the individual. Better care is about not just spending more money, but spending it much more wisely. The Health Committee made that point powerfully to us. Some councils do that well; others could do it better. That is why the Government are jointly funding with the Local Government Association work to support councils to release savings while improving the care and support they provide.

The Health and Social Care Bill will foster far greater integration between the NHS, social care and, importantly, other public services. Health and wellbeing boards will bring together democratically elected local councillors, directors of children’s services, adult social services and public health services, clinical commissioning groups, and, importantly, the public through Healthwatch, to improve services in our communities. They will identify local needs now and for the future and, importantly, be accountable for setting the strategy to meet those needs. The unprecedented transfer of money from the NHS to social care is creating new opportunities for joint working.

However, we have a long way to go to improve the quality of social care, especially for older people. Clinical audits on fractures or continence care; the parliamentary inquiry into the human rights of older people in health and social care; and damning reports by charities such as the Alzheimer’s Society and Age UK all point to the fact that health and social care in England is far from universally excellent. In too many cases, it is very far indeed from being excellent. There can be no excuses and no mitigating circumstances. Yes, there are excellent staff working in our services, but some staff need to be challenged, and some need to leave the profession because they do not do the right thing. We need to be honest. We need to applaud the good, but to shine a light where there is no good.

It is not a matter of not having enough staff. In some places—

--- Later in debate ---

[Tony Baldry (Banbury) (Con)]

I am grateful for the opportunity to contribute to this debate, not least as co-chair with Baroness Pitkeathley of the all-party group on carers. The first point I want to make is about the phrase “adult social care”. One of the difficulties in this area is that if we are not careful we develop a secret garden of policy and we all start to descend into shorthand—referring to Dilnot as though everyone understands the five paragraphs that follow from that. I thought that the shadow Secretary of State for Health made a good point when he said that, for many people, this is all about being afraid of getting old. I think that this should be about not adult social care but care of the elderly.

When the Law Commission was asked to define social care, the best that it could come up with was the phrase

“promote or contribute to the well-being of the individual.”

That was pretty otiose. We should focus on care for the elderly because we will need to enlist in our constituencies many more people to get involved in this, not least local councillors, with the introduction of health and wellbeing boards. I do not know about other hon. Members but, although I think that the provisions in the Health and Social Care Bill on integration are really good news—I will come on to that in a second—I do not sense that county councillors and others have yet woken up to the fact that shortly they will be part of the boards and will be involved in delivering integrated care. Part of the reason for that is that this has been a bit of a secret garden of policy. One of the things that Ministers will have to do in the near future is go out and talk to, in two-tier authorities such as mine, county councillors, but in others those councillors who are responsible for running social services, to get across the fact that the whole way in which services are delivered will fundamentally change.

About half the speeches this afternoon have been what I would describe as old-fashioned speeches to Ministers, saying, “Please can we have some more money?” The truth of the matter, as we all know, is that there is no more money. It is actually more challenging than that. We have the Nicholson challenge of 4% efficiency savings in the NHS over four years. We will make this work only if we completely rethink the way in which we deliver services. We all know of far too many people who are in hospital but could be moved elsewhere if intermediate beds were available. That would mean they could be moved out of acute beds, such as those at the John Radcliffe hospital or the Horton general hospital in Banbury, but that would require someone working out how to provide more community facilities and intermediate beds and how they would be paid for, and that will require a lot of rethinking by county councillors and GP commissioning bodies working together.

We have to start to put this in a language that everyone understands. When the White Paper is published in the “spring”—that leaves only April—there is a danger that we will all get fixated on Dilnot and the cap. It seems to me that that is just one part of the whole equation for improving care for the elderly and, increasingly, elderly people suffering from dementia. The figures on dementia are really pretty scary. Among the many organisations that produced briefings for today’s debate is the Alzheimer’s Society, which reports—I had forgotten this—that there are now nearly 750,000 people in the UK with dementia, and that figure is set to rise to over 1 million by 2021, when many of us expect still to be in the House.

Dementia costs the UK economy £20 billion a year. When I was first elected to the House, most Christmases I would visit the homes for the elderly in my constituency. The residents then were mostly spry widows in their 70s, but now all the homes are almost totally full of people suffering from dementia or age-related dementia. This is about how we care for the elderly and, increasingly, elderly people with dementia, many of whom are having to stay at home longer. Indeed, the Alzheimer’s Society says that more than half of the people suffering from dementia have not yet been diagnosed as such because their families or those are caring for them are probably disguising the fact.

[Barbara Keeley]

I do not know whether the hon. Gentleman thought that my speech was one of the old-fashioned ones asking for more resources, but he probably did. However, I gave three examples of cuts to services for people with long-term conditions: the support services for people with dementia that Age Concern was running; a community matron service; and active case management for people with long-term conditions. It is inexcusable for those to be cut. If the Nicholson efficiency reforms are causing those services to be cut there is no way forward, because those are the supports in the community that will keep people out of hospital. It seems crazy. I now have three examples, whereas at Christmas I had only one. I am distressed to think that those services are being cut, because they are the way to support those people in the community.

[Tony Baldry]

One of the advantages of having been in the House for a little while is that one spends some time on the Government side, some time on the Opposition side and some time on the Government side again—I hope not to be on the other side again but am quite content wherever. One of the things I have learnt is that which side one sits on does not change reality. The reality is that this challenge is so enormous that it will not be solved simply by all of us telling the Treasury, “You’ve given us £2 billion. Please can we have another £4 billion, or another £8 billion.” It will only be changed if we fundamentally rethink how we deliver services for the elderly. If all Members asked how many delayed discharges there were in the general hospitals in each of our constituencies, I suspect that we would find that it is a huge number—I am afraid that Oxfordshire is currently one of the worse offenders. We have to do better. We have to fundamentally rethink the whole way we deliver these services.