Social Care Funding

Baroness Keeley Excerpts

Wednesday 17th October 2018 Commons Chamber

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

I beg to move,

That this House notes that eight years of Government cuts to council budges have resulted in a social care funding crisis; further notes that 1.4 million older people have unmet social care needs; notes that Government grant funding for local services is set to be cut by a further £1.3 billion in 2019-20, further exacerbating the crisis; recognises with concern the increasing funding gap for social care; further recognises that proposals from the Government to invest £240 million will not close that gap; and calls on the Government to close the funding gap for social care this year and for the rest of the Parliament.

In October 2016, the Prime Minister told this House that her Government would provide a long-term sustainable system for social care that gives people reassurance. Then the Conservative manifesto said:

“Where others have failed to lead, we will act.”

But the Government have failed utterly to act and people in need of care have paid the price of that inaction. It is approaching a year since the Government promised they would deliver a Green Paper, yet it is still nowhere to be seen months after the planned publication date originally scheduled for summer. Since then, we have seen a further £1 billion cut from social care because of the cuts the Government have made to the budgets of the councils that deliver it, with disastrous consequences for the social care system.

The Prime Minister has not heeded her own warnings about failing to act. During last year’s election campaign, she said that

“the social care system will collapse unless we do something about it. We could try and pretend the problem isn’t there and hope it will go away, but it won’t. It will grow each year.”

That is exactly what has happened. The problem has not gone away and it has grown in the past year.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Does my hon. Friend agree that in addition to the immediate injection of £2.5 billion funding for social care, with 20% of the poorest local authority areas losing nearly £280 million in the past year compared with 20% of the most affluent local authorities gaining £55 million, we also need to address the issue in relation to the deprivation grant funding allocation?

[Barbara Keeley]

We do need to address that. Things have come to a pretty serious pass.

[Mr Jim Cunningham (Coventry South) (Lab)]

Following on from that point, one issue I have raised on a number of occasions in this House is the lack of local authority funding for social workers. We end up with a situation where people cannot be released from hospital—we used to call it bed-blocking. Does my hon. Friend agree that this is causing major problems both for local authorities and the patients concerned?

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[Barbara Keeley]

Indeed. My hon. Friend makes a really good point. I noticed that the number of delayed transfers of care due to care packages has started to rise, even though it is not fully winter—[Interruption.] Yes, they have, over the last couple of months. The Care Quality Commission has said that in some parts of the country the social care system has now reached the tipping point that of warned of two years ago.

The response from the Secretary of State was to announce that £240 million would be given to councils to deliver packages of home care to people this winter. That is nowhere near what is needed. The social care funding gap is already over £1 billion this year and, as my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) said, it will reach £2.5 billion by 2020 unless the Government intervene.

By my calculations, the Government’s offer will provide only three months’ of care packages for 70,000 people, so when the Secretary of State gets to his feet, will he tell us what will happen to people who need publicly funded home care when the money runs out? What plans do the Government have to provide care beyond the winter?

[Mrs Madeleine Moon (Bridgend) (Lab)]

For some people, it is not possible to wait for money to be available. A third of people who are diagnosed with motor neurone disease will die within one year and over half will die within two years. A delay of a matter of weeks can alter someone’s pathway towards death. Does my hon. Friend agree that there is no time to delay?

[Barbara Keeley]

I very much agree. In recent months, I have met carers of people with MND and one becomes aware of how much time presses on them.

Our motion deals with social care funding, but this debate is really about people, such as the people my hon. Friend just referred to. It is about how society treats older and younger adults, how we should enable them to live independently and with dignity, and how this Government are badly letting them down. I will look today at the damage caused by Government inaction—damage to vulnerable people who rely on social care to live with dignity, damage to the lives of unpaid family carers who have had to step in to care for their friends and relatives, and damage to 1.4 million hard-working care staff, many of whom are so badly paid and so overworked that they cannot deliver the care that people need.

[Layla Moran (Oxford West and Abingdon) (LD)]

I am not sure whether the hon. Lady knows that in Oxford this is now starting to affect the local NHS. The John Radcliffe Hospital had to suspend non-urgent operations on two separate occasions in March because 170 beds were being bed-blocked. Does she not agree that it is time to see the promised Green Paper on social care, before this winter?

[Barbara Keeley]

Indeed. As I said, it is now coming up to a year since that was promised and it is about time that we started to see some plans. However, we have to bear in mind that a Green Paper is only the first stage of change—and a very early stage at that, really.

I want to pay tribute to the care staff I just mentioned. There has been a lot of talk recently about low-paid staff and how they will fare in terms of migration policies. Being low-paid does not mean that caring roles are low-skilled. Caring staff are highly skilled. They are a credit to this country, and without their dedication the problems facing social care would be immeasurably worse. Unfortunately, their efforts cannot paper over the cracks that have emerged because of this Government’s hammer blows to council budgets. I will come on to talk about the impacts that social care cuts have on people.

[James Cartlidge (South Suffolk) (Con)]

The hon. Lady talked about the Green Paper and how we will fund this in the long term. Obviously, we all have to contribute to that. I was interested that in the last debate she said her party was looking at such things as a wealth tax. I wonder whether she has developed her thoughts on how we should pay for this and whether it will be considering a wealth tax.

[Barbara Keeley]

We have indeed been doing more work on this, but we laid out in our manifesto—the hon. Gentleman’s party did not—what our future plans for social care funding were. We said what the three options for funding social care were and that it would either be one of those three options, or perhaps a combination of all three—I think that the party that is being left behind here is his.

The impact of social care cuts means that less care is now available for older and younger adults alike. Four hundred thousand fewer older people got publicly funded care in 2015 than in 2010, and 1.4 million older people now have unmet social care needs. Put simply, that is over 1 million people who are not getting help with washing, dressing, going to the toilet, making meals or taking medication.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

The hon. Lady mentions the plans in the Labour party’s manifesto, but since then the Health Committee and the Communities and Local Government Committee have produced a joint report on the future funding of adult social care that unanimously recommends adoption of the German-style social insurance system. Will Labour consider those recommendations? Is she minded to support that cross-party recommendation?

[Barbara Keeley]

The hon. Gentleman asked me the same question six months ago, on our last Opposition day debate on this subject, and I will give him the answer I gave him then: he should really be trying to influence his own party. I thank those Committees for the work they did, as the Prime Minister did today. Labour has got as far as producing a White Paper—not a Green Paper. We have a 2010 White Paper, and I have a copy with me. I recommend that Conservative Members who keep asking about this look at the extensive proposals in that White Paper, which followed a Green Paper and an extensive consultation. The party being left behind is the Conservative party.

[The Secretary of State for Health and Social Care (Matt Hancock)]

For the information of the House, will the hon. Lady answer the question from my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake)? Does she support the measures recommended by the Select Committees—yes or no?

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[Barbara Keeley]

It is really up to the Secretary of State, whose party has not produced any proposals, to answer that. On the point about cross-party working, it is the Conservative party that has no proposals. The only proposals it has come out with are the damaging ones that have now been abandoned.

[Melanie Onn (Great Grimsby) (Lab)]

My hon. Friend is doing a very good job of reminding the Government that they are the ones in power and the ones with the decision-making powers. If they support the Select Committees’ report, they should bring forward their Green Paper and adopt them all in full. They have the opportunity to do that.

I want to ask my hon. Friend about unmet need and the growing gap between social care funding and continuing healthcare funding. I am increasingly seeing severely disabled individuals in my constituency with very high levels of need being bounced from pillar to post between continuing healthcare funding and social care funding, neither of which is meeting their needs. What does she suggest the Government do to bridge that gap?

[Barbara Keeley]

I suggest that the Government start with the cash injection that our social care system needs. The Labour party promised a £1 billion injection upfront to ease us out of the crisis and £8 billion across this Parliament. I suggest that that would be a starting point and that the Conservative party then tell us how it will fund social care in future.

[Several hon. Members rose—]

[Barbara Keeley]

No, I will not give way; we have very limited time.

As my hon. Friend the Member for Great Grimsby (Melanie Onn) just said, the effects of reduced access to care are very keenly felt, especially by older people, but I want to highlight what happens to young adults with learning disabilities and autism when there is too little funding to support them in the community. A recent BBC “File on 4” programme on transforming care highlighted the impact on young people with autism or a learning disability of being kept in assessment and treatment units for long periods.

The nature of these settings is chilling. A young woman with autism and extreme anxiety called Bethany, aged 17, is being kept in seclusion in St Andrew’s Hospital, Northamptonshire, in a cell-like room and fed through a hatch in a metal door, at which even her father must kneel to speak with her when he visits. She is being detained and held in seclusion despite an assessment that the current hospital setting cannot meet her needs and a recommendation that she be moved to a community residential setting with high support. As “File on 4” pointed out, however, moving a young person such as Bethany to a community setting would involve her local council paying £100,000 to £200,000 a year from the adult social care budget, instead of leaving the NHS to pay what is a much higher bill—in this case, £676,000 a year, or £13,000 a week.

The lack of funding is clearly a factor here. Bethany’s dad was told by the Walsall Council officer responsible for her placement that her care had already cost the council £1.2 million. To be frank, he said, “Walsall could do with a breather.”Bethany is being treated shamefully. It is hard to imagine someone making a similar comment about the cost of treatment for a young person with cancer.

Bethany’s case highlights a growing problem which is part of the crisis in adult social care. Underfunding social care places people with a learning disability or autism at risk of being left for long periods in institutional care settings. Now that I have raised this case, the Secretary of State must look at the state of funding, which leads to perverse incentives for private hospitals like St Andrew’s to charge the NHS for keeping vulnerable young people with autism or learning disabilities in expensive and unsuitable placements because the local council does not have the resources to fund a community placement.

The journalist Ian Birrell recently wrote about Bethany’s being kept in those appalling conditions, in seclusion in a tiny cell. He asked, “Have we moved far from Bedlam?” The answer is, I am afraid, that we have not. The transforming care programme is making hardly any progress. The most recent data, published in May this year, show that 2,400 people—people like Bethany, with a learning disability or autism—are still in in-patient units, and that is an increase from an earlier figure. Many people in such units are subject to over-medication, inappropriate restraint and seclusion. They can be far from home, and they can be kept there for a very long time. The average stay is more than five years.

As the National Audit Office found, such placements are extremely expensive. In 2012-13, the NHS spent £557 million on people with a learning disability in mental health hospitals. Will the Secretary of State tell us why the Government are still funding the institutionalisation of so many people with learning disabilities, or autism, at great cost, seven years after the scandal of Winterbourne View, after which they promised to cut those placements by half?

[Dr Sarah Wollaston (Totnes) (Con)]

The very troubling case that the hon. Lady has described illustrates why we, as a House, must get this right. Does she accept that there has been political failure to resolve the issue of how we fund social care, and will she commit herself to taking a constructive, cross-party approach to getting it right?

[Barbara Keeley]

The hon. Lady has asked me that question a number of times, and I always find it difficult to answer. She will know that my party really tried, but when we produced that White Paper in 2010—when we had a way forward and a set of funding proposals—all that we heard was “death tax”. In last year’s Budget, the Chancellor raised the issue of the “death tax” again: he said that it was not an option. I wonder how the hon. Lady thinks that Labour Members can talk to a party whose Chancellor has ruled out one of the options right at the start, before anyone sits down and discusses anything. I think that that is impossible. I value the hon. Lady’s role as Chair of the Health Committee, of which I used to be a member. Perhaps she will write to the Chancellor, and ask him to stop doing that.

[Dr Wollaston]

As the hon. Lady will know, this is a pattern that has pinged backwards and forwards with successive Administrations. I repeat that we must get it right. We cannot continue these cycles of political failure. We will only solve the problem—particularly in a hung Parliament—with a constructive, cross-party approach.

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[Barbara Keeley]

I am constantly astonished when Conservative Members talk about a cross-party approach. It is up to their party to come up with some proposals. When it has some proposals, there will be something to talk about. All that we have seen the Conservatives do is to abandon all the proposals that they have previously had. We legislated, in the Care Act 2014, for a cap on care costs and a lifting of the ceiling—the asset threshold—but the Conservatives have abandoned that now. They had a set of policies at the time of the election last year, but they have abandoned that. The hon. Lady needs to speak to her own Secretary of State, and I hope that she can have a constructive conversation with the Chancellor as well.

The Government’s cuts have not just reduced access to care in the ways that I have outlined; they have reduced care quality. Cuts mean that there is less good-quality care, which causes great indignity to both older and younger adults. The Care Quality Commission tells us that one in five care services—about 4,000 facilities—requires improvement or is inadequate. In too many care facilities quality is hanging by a thread largely because of the good will and dedication of care staff, but there are times when even their efforts cannot prevent standards falling. In a recent case in Tameside a care home rated inadequate was eventually forced to close for financial reasons. Care home staff were not only not being paid themselves, but they had paid out £5,000 for the food for care home residents, and an agency was owed £37,000 to pay care staff. An earlier CQC report had noted that that care provider had been made bankrupt. During the time before this home was closed, care quality was scandalously low. In 2017 the CQC found that one resident had been left in bed for five months without a bath or shower. It beggars belief that the Government think that care home managers in such situations should be given responsibility in the process for assessing a cared-for person’s mental capacity under the proposed mental capacity legislation currently in the other place, but that is what the Bill currently says—even care home managers in that failing home would be given a part in the process of assessing mental capacity—and it seems that the Government will not shift from that. I join others in the other place and urge the Secretary of State to pause the passage of the Mental Capacity (Amendment) Bill and listen to the concerns being raised about his proposals, because that is not a role that should be dumped on care home managers in the way the Bill is trying to do.

[Thelma Walker (Colne Valley) (Lab)]

The Kirklees Solidarity Economy Network in my constituency is working to establish a community-based care co-operative. The model it is developing seeks to demonstrate that a better way is possible by putting people before profit, valuing, rewarding and respecting careworkers, and ensuring that the people receiving care and the workers providing that care have a real say in how the service is run. Does my hon. Friend agree that we could all look to that model in the future?

[Barbara Keeley]

I very much do and thank my hon. Friend for making that point. There is a great place for co-operatives and mutuals and other such organisations. Organisations like Shared Lives are producing outstanding care in some parts of the country, and we must look at all those models.

I want to talk about hard-pressed family carers, because the situation of less care and lower quality care means that family carers are under pressure as never before to step in and provide care. The strain of caring has seen almost three quarters of carers suffer mental ill health and nearly two thirds suffer physical health problems, according to Carers UK. But too few carers can access respite from caring; they are at breaking point.

Problems with poor care quality and a lack of support were highlighted earlier this year in a report by Age UK entitled, “Why call it care when nobody cares?” At the launch of that report, both I and the Care Minister heard from carers like Joyce. At 73, Joyce cares full-time for her husband David who has had a stroke and a massive brain haemorrhage. Joyce has to do everything for David to make sure he is

“clean and comfortable at all times”.

That involves regularly lifting him in and out of his bed or chair to wash him, or take him to the toilet, throughout the day and night. She said:

“It is extremely hard to get good respite care where we live in Cheshire. Our local care home is no longer an option due to being cut as a provider by the local council. I had to fight tooth and nail for the care David currently gets in a day centre—but it just isn’t enough.

I don’t know how I’ll continue to cope without more support and regular respite breaks. Our care was cut in March, the third time that we have had respite care pulled. I am so angry and frustrated, I am so worried at what is facing us at the moment I hardly dare think about it.”

What carers like Joyce need is comprehensive support and carers breaks to allow them to look after themselves as well as the person they care for. What they have received from the Government is the damp squib of a “carers action plan” in place of a proper national strategy.

Labour has already pledged to deliver a national carers strategy as we did with our second national strategy in 2009. That national carers strategy pledged £150 million of funding for respite care breaks for carers. That funding has now disappeared into a black hole in the better care fund, leaving carers like Joyce to fight “tooth and nail” to get any respite at all.

[Kevin Hollinrake]

rose—

[Barbara Keeley]

I must make progress.

For care staff, the combination of cuts to social care funding and increasing demand for care has created the perfect storm of pressures, affecting the quality of care. Care staff themselves are reporting seeing a major decline in standards of care over the past couple of years.

Kim, one member of care staff, told her trade union, Unison, that she

“found it increasingly difficult to provide a good standard of care because of staff shortages and the greater need of clients. Often visits to clients have to be rushed, making medication mistakes by staff more commonplace and no social time for clients.”

Another care home staff member from Lancashire said that

“a lot of the time it feels like we are operating a ‘people warehouse’ and just offering the basics of feeding and personal care.”

I find those comments deeply troubling. They show the direct human impact that the underfunding of social care is having. Staff are rushing from one appointment to another, with no time to talk. They are being seen as

“heartless robots as opposed to a lifeline service”.

That is how one care home staff member described her job. Care staff are some of the most dedicated and highly skilled workers in this country, but these pressures, added to their pitifully low pay and their poor terms and conditions, are driving people from a sector where they have never been needed as much as they are now.

The care sector is teetering on the edge of a cliff. Without an urgent response from the Government, it could topple altogether. Ministers in this place talk glibly about making hard choices, but the truth is that this Government have chosen to pursue austerity on the backs of older people and vulnerable adults, who rely on social care. If austerity is now over, as the Prime Minister has claimed, the Government must put in the funding that social care needs to bring it back from the brink.

At last year’s election, Labour outlined a plan to invest an additional £8 billion in the social care system. We want to lift the quality of care and to lift access to care and support for carers before moving on to build our new national care service, as outlined in our White Paper. The Prime Minister said last year that the Government would act. They must now commit to a sustainable long-term funding plan. I urge hon. Members to vote for our motion tonight, to ensure that the Government honour the Prime Minister’s promise, because the people who need care, their family carers, and the care staff who care for them deserve better than this.

[The Secretary of State for Health and Social Care (Matt Hancock)]

Each and every one of us in this House recognises and values those who care, from care workers to nurses to the millions of unpaid carers who look after loved ones. I think the whole House can unite behind the statement that how we care for the most vulnerable is a mark of our civility as a society. Across our country, in our NHS and in our care homes, so many people dedicate their lives to caring for others. I want to address the pressures we face in our social care system in the short term, as well as the long-term reforms we must take to ensure that our social care system is sustainable and fit for the future.

Right at the start, I want to address the individual case of Bethany, which the hon. Member for Worsley and Eccles South (Barbara Keeley) rightly raised. On seeing the reports of the case in the media, I immediately asked for an investigation inside the Department, along with NHS England and the Care Quality Commission. This is clearly a distressing case—it was initially brought to my attention by Ian Birrell—and we will get to the bottom of it. More broadly, the number of in-patients is now down to 2,375, a fall of 17% from March 2015, including 600 who had previously been in hospital for five years or more. So there has been some progress, but there is clearly more to do and the hon. Lady was right to raise the issue.

[Barbara Keeley]

I gave the House a statistic of 2,600. Bethany’s dad, who is campaigning on her behalf, wants to see her in a proper community placement, but there are thousands of Bethanys. This is a serious matter. We had a debate here on transforming care a few months ago, but very little has happened since.

[Matt Hancock]

As I said, progress has been made. There has been a reduction of 17% in the number of in-patients—down from 2,875 in March 2015 to 2,375 on the latest figures—but I would fully acknowledge that there is more to do and I am determined to see that happen.

Our population is ageing. More people are living longer and, as a society, we must address the challenge that that creates for social care. To put that into context, over the next 25 years, the number of people aged 75 and over is set to double and the number of people aged 85 will rise by more still. Of course, this is good news. It is down in part to the hard work of our NHS. Cancer survival rates are at a record high and strokes are down by a third, but with such successes come new challenges. For instance, we are seeing a rise in dementia and in age-related conditions, with 70% of people in residential care homes now suffering with dementia.

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[Barbara Keeley]

On a point of order, Madam Deputy Speaker. Yet again the Government sit on their hands and refuse to vote on a key social care motion. We have heard in this debate some moving cases of people whose lives are being damaged by the crisis in social care, but no solutions from the new Secretary of State for Health and Social Care. We do not need more warm words which we have just heard from the Care Minister and other Ministers. We need action to close the funding gap. If the Government disagree with our motion, they should have the guts to vote on it, and shame on them for not doing so.

[Madam Deputy Speaker (Dame Rosie Winterton)]

The hon. Lady has put her point of view on the record. As I am sure she knows, there have been undertakings by the Government that in response to situations like this there will be a report back to the House at a future date, and I am sure those on the Treasury Bench will have heard the points made.