Social Care Provision and the NHS

Baroness Keeley Excerpts

Thursday 3rd May 2018 Westminster Hall

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

Thank you, Dame Cheryl, for calling me to speak; it is an honour to serve while you are in the Chair.

I, too, am glad that we are actually having this debate, now that we have all got here, and I congratulate my hon. Friend the Member for High Peak (Ruth George) on securing this important debate and on the way that she opened it. It is never easy for someone if they are rushing in at the last minute, because they were delayed by something outside their control. Nevertheless, what we heard from her was a comprehensive review of the issues in social care in her constituency, which I found very useful.

In addition, I thank the hon. Member for Glenrothes (Peter Grant), who is the Scottish National party spokesperson, for a thoughtful contribution. Broadly, I do not disagree with him, but part of the difficulty for Opposition parties is that we have some very substantial disagreements about spending priorities, which is what we end up talking about quite a lot.

Before discussing the effect of social care on NHS provision, which is the topic of our debate today, I pay tribute to both our hardworking NHS staff and the 1.4 million dedicated staff working in care, many of whom —as we heard in my hon. Friend’s contribution—are on low pay, undervalued and overworked. I keep that point in front of me, because it is a very important aspect of social care.

Nurses Day is on 12 May and I pay tribute to the outstanding patient care that nurses give, in the diverse roles that nurses have in healthcare teams, ranging from acute care, which is clearly very important to patients, to Marie Curie nurses in palliative care—there are not enough of them—and to Admiral nurses in dementia care, who are very important too.

Today’s debate is an important opportunity to discuss the interaction between social care and services provided by the NHS, but it is always important to keep in mind the positive role that social care plays in the lives of older people and younger people with care needs, because it helps them to live independent lives. The Secretary of State recently told a conference of social workers:

“We need to do better on social care.”

I agree with him, but the Government have had eight years to do better on social care and yet things have got worse. My hon. Friend rightly pointed to the eight years of cuts to council budgets, which have meant that more than £6 billion has been taken from social care budgets since 2010. That is a serious factor.

My hon. Friend talked about how Government cuts to local authority funding have had an impact on social care services in Derbyshire. I understand that there has been a 40% budget cut already, with further cuts happening this year. She also outlined how the clinical commissioning group, which is an important body in the work on integration and commissioning, is now in special measures because it is in the red. In whatever spirit we are approaching this debate, we have to take it on board that cuts have consequences. As we have heard, cuts to social care budgets have consequences for the NHS. For example, they tie up ambulance paramedics when they could be getting to stroke patients—patients they need to get to. Cuts have consequences for the quality of care and the burden that falls on family carers. I will refer to each of those issues.

We have heard about the diminishing care fees that councils are able to pay in light of cuts. That has further destabilised a care sector that, we have to face it, has been described as “perilously fragile”. The Association of Directors of Adult Social Services reported last year that two thirds of councils had seen care providers close in their areas, and that care providers handed contracts back to more than 50 councils. The Competition and Markets Authority has warned that many care homes could find themselves forced to close or to move away from local authority-funded care. As my hon. Friend said, local authority funding is only just covering day-to-day running costs. Just this week in Trafford, care provider Ampersand Care has closed two homes, blaming chronic underfunding of care for older people. It claims that it cannot provide safe care at the rates offered by Trafford Council. Those closures will see 78 residents face the upheaval of moving from their current home. The reality of our unstable care market is that such instances are becoming commonplace. In fact, just a few weeks ago the same care provider closed a care home in Swinton in Salford, which is my local authority. Now that care provider has only one care home left in the country.

There is a growing funding gap in social care that must be filled. We would not be suffering quite so badly from these issues if we addressed that. The Local Government Association has estimated that our social care system needs an immediate injection of £1.3 billion to fill the gap, and the King’s Fund reports that that will rise to £2.5 billion by 2020. What Members said about the different views people have was interesting. Cuts to social care have led to what the Secretary of State recently described as “unacceptable variation” in the quality of services. We will never address the future funding of social care while we have a quality problem. If we are expecting people to pay more, why should they pay more for services that are not good quality?

As my hon. Friend the Member for High Peak said, one in five care facilities receives the lowest quality rating from the Care Quality Commission. My party’s research revealed that more than 3,000 care facilities with the lowest quality ratings continue to receive the lowest ratings, even after being re-inspected by the CQC. The care facilities find themselves unable to get out of that situation. Cuts mean that providers have less money to pay staff and to invest in training or building renovations, and that can lead to what we are seeing now. Facilities are getting trapped in a cycle of poor quality care provision.

Care staff, who so often are underpaid, undervalued and overworked, are under intense pressure as a result of cuts. My hon. Friend spoke about the challenges with social care in her own constituency, much of which is rural. Many of the problems she described relate to staffing, and they are not isolated examples. Rural England’s 2017 report, “Issues Facing Providers of Social Care at Home to Older Rural Residents” discusses the challenges facing social care provision at home for people in rural communities. Rural populations are typically older. There is a lack of specialist housing for older people and housing stock is older, which may mean it is difficult to heat. Those challenges are compounded by difficulties in recruitment and retention, as we have heard today. Home care staff are typically being employed on zero-hours contracts and receiving payment for actual contact time only and not for travel time. That is true in London and Salford, but in rural areas, where the distances are much greater, that lack of paid-for travel time is a different issue. It could make the difference between people being prepared to work in care or not.

In addition, rural social care has to contend with such factors as a small pool of potential employees, competition from other employment sectors and a mismatch between the locations of care staff and those of people who need care. My hon. Friend gave an important example of one town where 19 people are waiting for a care package. Other national trends affecting the care sector also affect rural areas. They include: low pay, few career opportunities or chances to gain skills, and the increasingly complex needs of people in need of care.

People who need care in rural communities need the Government to think ahead and monitor emerging trends properly to ensure that there is proper coverage in their areas. Worryingly for the future of provision in these areas, Rural England’s report

“found scant regard to rural proofing”

in the sustainability and transformation plans that it had seen. Moreover, it said that:

“published statistics seldom provide, or...facilitate, any rural analysis.”

That needs to be rectified if rural social care needs are to be more than just an afterthought.

We have heard that a lack of good-quality care places an additional burden of caring on unpaid carers. Older rural residents are more likely to provide some form of care to one another—24% of people in rural areas do that, as compared with 18% in urban areas. The issues for carers are more marked in rural areas. I have worked on carer issues since 2002, when I worked as an adviser to the then Princess Royal Trust for Carers, which is now the Carers Trust. That work included the then largest ever national survey of carers to assess the impact of the Labour Government’s carers strategy, which was published in 1999, on carers’ lives. I researched and published three reports on the needs of carers. I wanted to highlight that work from before I was elected to underline how important a national carers strategy is to carers.

I want to raise with the Care Minister how carers have been treated by the Government in recent months with the abandonment of the promised carers strategy. Their needs are being subsumed into the Green Paper on social care for older people, and I want to highlight how one carer feels about that. Katy Styles is a carer and a campaigner for the Motor Neurone Disease Association. She contributed to the Government’s consultation on the national carers strategy because she hoped that her voice would be heard, alongside the 6,500 other carers who also contributed their views. She told me:

“Not publishing the National Carers Strategy has made me extremely angry. It sends a message that carers’ lives are unimportant. It sends a message that Government thinks we can carry on as we are. It sends a message that my own time is of little worth.”

Katy Styles started an e-petition on the issue. It is e-petition No. 209717, which is titled:

“Government must publish a Carers’ Strategy and not a Carers’ Action Plan”.

She sent me this message yesterday:

“Whilst unpaid carers save the UK economy an estimated £60 billion annually, this government fails to value our contribution.

As unpaid carers struggle financially, government fails to give them a reasonable allowance. Whilst unpaid carers spent precious time informing a Strategy, that time and effort was wasted as that Carers Strategy was apparently scrapped. That’s how much carers’ lives matter.

A national strategy would set the tone on how society should value and support carers. Without a strategy, carers have no hope of being valued and supported.”

I support Katy Styles and her campaign. She and other carers do not have much time to spare, and when they do respond to a Government consultation, their input should not be abandoned. As I mentioned last week in our Opposition day debate, this Government have launched more than 1,600 consultations since 2015. More than 500 of those consultations have not yet been completed, and it is sad to note that that includes the carers strategy.

Thinking of ourselves as a group of politicians, we have to be careful that we do not over-consult people. We cannot throw out consultations and reviews as things for people to respond to and then not care whether they get any review of their input or not do anything with what they say. The day that people feel it is not worth putting their time into consultations will be a serious point for us as politicians. It is important that people believe that their input is valued and that we take what they say into account.

I have only been a remote carer, but I feel that I have worked enough with carers to understand their issues. We should take what they say seriously. I hope the Minister can say more than what she has said in the past, which is that a carers action plan will be published shortly. Can she tell carers such as Katy Styles why the planned carers strategy was abandoned?

The funding crisis in social care also has an impact on the growing number of people who are in need of care, but get no care at all, as the hon. Member for Glenrothes mentioned. We know that more than 1.2 million people, many of them isolated and lonely, are now living with unmet care needs. Recent research has recognised that living in rural areas may exacerbate the social isolation of older residents, and of course that goes for their carers too. As the King’s Fund has stated:

“Access to care depends increasingly on what people can afford—and where they live—rather than on what they need.”

The impact of the lack of social care on NHS provision is most regularly seen in the context of delayed transfers of care—my hon. Friend the Member for High Peak talked about the situation in Derbyshire. Although the figures for delayed transfers of care attributable to lack of social care have dropped in recent months, they reached record highs under this Government, causing thousands of people to be stuck in hospital while waiting for arrangements to be made for their care at home, or for a place in a care home. The latest figures, from this February, remained stubbornly high relative to the same period in 2015 or 2011.

It is also open to question whether people are getting the care they need in the community when they are discharged from hospital, a point I raised in last week’s debate. A recent report from the British Red Cross showed that older people could become stuck in a vicious cycle of readmission to hospital because of a lack of adequate care in the community. Reductions in delayed transfers of care will mean very little if there is insufficient social care to support people when they are discharged.

As my hon. Friend said in her speech, a lack of suitable care at home for patients needing palliative care means that people have to remain in hospital to the end of their life, sometimes with heartbreaking consequences. I was glad to hear that at least one person managed to get his wife home for those last few days, because that is very important. However, if many other family members cannot reach the hospital to visit, that is very serious.

The 2015 national survey of bereaved people by the Office for National Statistics found that, while only 3% of those who stated a preference wanted to die in hospital, nearly half of the 470,000 people who died in 2014—some 220,000 people—died in hospital. A 2016 report from Marie Curie found that hospital admissions at that point were unsustainable, and too many people who were approaching death spent long periods in hospital due to a lack of alternative social care support.

I hope the Minister will address that point, and perhaps shed some light on what is being done to reduce the number of people who are denied a choice at the end of their life, in line with the Government’s response to the choice review, which said that the Government

“will put in place measures to improve care quality for all”

and

“will lead on end of life care nationally and provide support for local leadership, including commissioners, to prioritise and improve end of life care”.

From the examples that we heard from my hon. Friend, it sounds as if there remains some way to go on that in Derbyshire.

The social care system now badly needs sustainable funding from central Government, both for the future of the NHS and for the many people who now rely on social care. I remind those few hon. Members who are here that, at the 2017 election, Labour pledged an extra £8 billion for social care across this Parliament, with an extra £1 billion to ease the crisis in social care this year. It is important to keep looking at that figure, because that would have been enough to begin paying care staff the real living wage. It would have helped to ease the recruitment crisis that my hon. Friend has talked about in her area of High Peak, and would have enabled more publicly funded care packages for people with different levels of need. Most importantly, it would have allowed us to offer free end-of-life care to all those who needed it.

I believe we need urgent action to avert the care crisis, and the time to act is now, both for the sustainability of the NHS, which as we have heard is really being affected by shortages of social care, but most importantly for the people who depend on care to live independent, fulfilled lives.

[The Minister for Care (Caroline Dinenage)]

It is a great pleasure to serve under your stewardship, Dame Cheryl. I thank the hon. Member for High Peak (Ruth George) for securing the debate and setting out the issues so articulately. I congratulate her on making it to the debate, and I thank you, Dame Cheryl, for allowing it to take place. It would have been a great concern to us all if that had not happened.

As hon. Members will know, I am relatively new to my role as the Minister for Care in the Department of Health and Social Care. That is why I am really grateful for the chance to focus on the interface between social care and health, and to outline how integration is absolutely at the heart of what we do. The renaming of the Department of Health as the Department of Health and Social Care must be more than just a change of title; it must provide a sense of direction and a change of culture. We know that health and social care are umbilically linked, and that one is a key driver of the other.

We recognise that many of our challenges stem from the very good news that people are living longer, which is to be celebrated. Worldwide, the population aged 60 or above is growing faster than all other age groups. In developed countries the proportion of the population aged 65 and above is expected to rise by 10% over the next 40 years. That means that, in England, by 2026 the population aged 75 and above, which currently stands at 4.5 million, will rise by 1.5 million. By 2041 it will have nearly doubled.

People’s expectations and wishes are also changing. The traditional model of social care is based on care homes, but we know that increasingly people want care to be delivered in their own homes. We want to encourage people to live independently and healthily in their homes, where many people want to stay. We know that nine in 10 older people live in mainstream housing, and that only 500,000 of those homes are specifically designed for their needs. Adapting homes to make them more suitable is therefore incredibly important. The disabled facilities grant has a vital role to play. Home adaptations and investment can be incredibly effective. Not only do such adaptations allow people to lead independent healthy lives, but our analysis shows that for every £1 spent, more than £3 is recouped, mostly through savings to the health and care system. Housing that enables people to live independently and safely allows us to reduce the number of people who need to go into hospital or have other social care requirements.

We have to look at the way we provide and fund services for the long term. Complex conditions must be addressed, and we must move to a system in which care, whether social care or health care, is individually tailored to people’s needs. The hon. Member for Glenrothes (Peter Grant) put it beautifully when he talked about how we need to stop using social care and our health service as a political football. We need to champion where there is good practice, not just talk about where it is bad. We need to look at how we can produce much more person-centred care, where we address an individual’s needs. We need to celebrate the amazing places up and down our country where it is going right, and we need to support the incredible workforce in this country—both the informal workforce, and the dedicated hospital and social care workforce. A number of pieces of work are ongoing. As the hon. Gentleman said, we need to have the courage to tackle the difficult questions, and that is what is happening.

A number of key pieces of work are happening at the moment to address many of the issues that the hon. Member for High Peak raised. Many of those issues will be tackled in the forthcoming Green Paper. We have an ongoing workforce strategy that is taking place jointly between Health Education England and Skills for Care. In order to address the challenges of our ageing population, we need to attract more people into the workforce. We need to ensure that they are properly rewarded for their work, that there is continuous development within that work, and that we attract people from a much more diverse range of backgrounds.

As the hon. Member for Worsley and Eccles South (Barbara Keeley) said, we also have a carers action plan, which is to be published shortly. She spoke about her constituent, Katy Styles.

[Barbara Keeley]

The person I was talking about is not a constituent; she is a national campaigner for the MND Association, and she has an e-petition. It is important to note that she is running a national campaign.

[Caroline Dinenage]

I am grateful to the hon. Lady for clarifying that. I would say to Katy Styles that the decision about whether it is called a strategy or an action plan was taken before I was in my role, but an action plan sounds to me like a much more positive thing.

Actions speak louder than words. We are talking about not just a sense of direction, but what we are doing and how we intend to do it. That is why the carers action plan will be a really important piece of work. I massively value the work of carers up and down the country—indeed, my mother was one—and I want to ensure that we properly recognise and reward what they do. We must be doing what we can, and not just through the Department of Health and Social Care but in collaboration with colleagues across Government, to help and support carers and ensure that the issues they face on a daily basis are tackled.

[Barbara Keeley]

It is worth clarifying this point while the Minister is talking about the action plan. I told her that I did that piece of work years ago on the first national carers strategy, which came out in 1999 and went right across Government. The difference I see is that that was signed by many Departments, with commitment from those Secretaries of State, but the action plans under the coalition, and those we have seen recently, are just signed by Social Care Ministers; they are very much smaller things. Departmental action plans are not the same as cross-Government national strategies, and I understand why carers feel that strongly.

[Caroline Dinenage]

The hon. Lady has a surprise coming—this action plan is signed by Ministers from across Government.

The hon. Member for High Peak raised cost pressures. We can all admit that local authority budgets have faced pressures in recent years. They account for about a quarter of public spending, so they have had a part to play in dealing with the historic deficit that we all know we inherited in 2010. That means that social care funding was inevitably impacted during the previous Parliaments. However, with the deficit now under control, we have turned a corner.

Thanks to a range of actions taken since 2015, the Government have given councils access to up to £9.4 billion of more dedicated funding for social care from 2017-18 to 2019-20. Local authorities are therefore now estimated to receive about an 8% real-terms increase in access to social care funding over the spending review. In Derbyshire, the hon. Lady’s local council has seen an increase of £33 million in adult social care funding from 2017-18 to £201.8 million, which is above the 8% figure—it is a 10.3% increase on the previous year. The Care Act 2014 places obligations on local authorities and the extra funding is designed to help them meet those obligations.