Adult Social Care

Barbara Keeley Excerpts

Wednesday 8th March 2023 Commons Chamber

[Mr Clive Betts (Sheffield South East) (Lab)]

I thank everyone concerned for the opportunity to lead this debate on behalf of the Levelling Up, Housing and Communities Committee. Adult social care is an important issue, which the Committee has come back to on several occasions.

Last year, we produced another report on long-term funding for adult social care. We were happy to receive letters, in the last couple of days, from the Under-Secretary of State for Levelling Up, Housing and Communities, the hon. Member for North East Derbyshire (Lee Rowley), and the Minister for Health and Secondary Care, the hon. Member for Colchester (Will Quince), both saying why they have not yet responded to the report that was produced around nine months ago.

As you know, Mr Speaker, the advice is that Government should respond to Select Committee reports within eight weeks, so eight months seems rather a long time. I know that there have been quite a few changes of Minister during that period, so perhaps that explains some of the delay. If this was just a one-off, it would probably be excusable, but the Select Committee rarely gets a response within months, let alone weeks, of a report being produced, which is a little frustrating when we have put so much effort into them. We have not even had a proper response to the joint report that we produced with the Health and Social Care Committee back in June 2018—almost five years ago, which must get near a record for non-responses to Select Committee reports. The Health and Social Care Committee has also done its own reports into these matters, as have many reputable organisations, such as The King’s Fund.

Given the nature of the debate, I will concentrate on the impact on local government funding. Although social care, as a responsibility, lies with the Department of Health and Social Care, it is ultimately delivered through funding from local councils. I want to concentrate on the challenge that that poses for councils. This is not a new matter and is not without a lot of commitments. Only last year, the right hon. Member for South West Norfolk (Elizabeth Truss) said that she would spend £13 billion raised by the levy on social care. Well, the levy seems to have disappeared into other uses, as has the £13 billion.

The right hon. Member for Uxbridge and South Ruislip (Boris Johnson) said:

“I am announcing now—on the steps of Downing Street—that we will fix the crisis in social care once and for all”.

Not to be outdone, the right hon. Member for Maidenhead (Mrs May) said that her Ministers

“will work to improve social care and will bring forward proposals for consultation.”—[Official Report, 21 June 2017; Vol. 626, c. 35.]

Let us go back a bit further. David Cameron said:

“A commission will be appointed to consider a sustainable long-term structure for the operation of social care.”—[Official Report, 25 May 2010; Vol. 510, c. 31.]

I will not just be party political in this, because Gordon Brown said:

“Alan Johnson and I will…bring…new plans to help people to stay longer in their own homes and provide greater protection against the costs of care.”

The one thing that Prime Ministers have in common over the years is that they all promise to deal with the problems and funding of social care. The other thing that they have in common is that none of them has actually done that, and that is something of concern and it is why we still have the problems today.

Let me put this in the context of local government funding. Local government has had the biggest cuts of any part of the public sector since 2010. The National Audit Office and the Library have produced some interesting figures, which are known to be authoritative. They have said that the cut in core spending power for councils in the decade after 2010 has been 26%. By comparison, the increase in funding for the Department of Health and Social Care has been 14%. So that is 26% down for local government and 14% up for the Department of Health and Social Care. I am not begrudging the extra spending on health, but, clearly, councils also do important work and that is not really reflected in the figures.

The reason for that cut in spending power is that the revenue support grant has fallen by 37% over that similar period. A 25% increase in council tax has helped cover some of that fall. Council tax spending as a percentage of total local government spend—the percentage funded by council tax—has gone up from 41% of local government spend to 60%. In other words, council tax has been going up as the Government grant has fallen, but the totality of spending has fallen as well.

Councils’ spending on social care—social care as a whole, including children’s care—has risen by 8.9% in real terms, but non-care spending by authorities has fallen by 32%. That is the knock-on effect—we must keep reminding ourselves of the consequences of this. Social care spending has now roughly risen from 50% of council spending to 60% over the period. Those are very dramatic changes in how councils spend their money.

Let us look at services such as planning. I know that they are important for the future of our country, for future growth and for regeneration. Spending by councils on planning has fallen by about 50%. That is a staggering fall. There have been similar falls in regeneration and economic development, which will be important for the levelling up agenda.

Let us look now at libraries, buses and street cleaning, which are important services that everyone tends to use in some way. They have all fallen by between 30% and 50%. The real challenge for local democracy—the Minister on the Front Bench has responsibility for local government—is that people are now finding that their council tax is going up by amounts that I have just described, but, if they or their immediate relatives do not use social care, they are seeing all the services that they receive fall. That is a fundamental challenge for local democracy—people pay more and get less. That is not defensible in the medium term, but it has been going on for 10 years now, and something has to give.

We might think, “Well, it’s alright as long as social care is sorted out,” but it is not, is it? Let us just look at the particular problems with social care and social care funding. Before the autumn statement last year, the Local Government Association said that it thought that about £7 billion was the shortfall currently. I appreciate that the Minister will no doubt advise us of all the goodies that were delivered in the settlement for the next financial year, and, clearly, there were some helpful increases of money, but not the £7 billion that local councils were looking for. The problem is that that settlement contains some of the elements of the problems that we have been experiencing for a decade or longer now. First, so much of the funding councils get is short-term. Yes, the better care grants and the social care grants are welcome, but much of it is on a one-off basis. Much of last time’s settlement was on a one-off basis, with the extra money coming in those forms of grants, together with the increases in council tax I mentioned previously.

We know there are two fundamental problems with increases in council tax: first, they raise far more money in the most affluent communities than in the poorest communities, and secondly, they are regressive—not my word, but the Secretary of State’s. I know the Minister has been charged with finding a solution to that problem. Good luck to him—we look forward to his report in due course, and we had an interesting dialogue with him in the Select Committee the other week. We are asking more from people on low incomes with proportionately lower house values, and giving less to the poorest communities through the increases. That is not the best way to fund social care in the longer term.

We know that, although funding has been going up, demand is rising. There are more unhealthy people in our communities, as we all know; we can see the figures for ourselves. Often forgotten, however, is the rising demand from people with disabilities. People with a whole variety of disabilities, both learning and physical, are living longer. Where they might have died in their 30s, they are now very often living into their 50s, to the point where parents who once looked after them can no longer help or support them. Those parents are worried sick about what will happen to their children when they no longer have that parental support available. That demand must also be met and recognised.

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

Will my hon. Friend reflect on the fact that, when local authority spending on social care is squeezed and the demand goes up, as he describes so well, the work of caring is then passed on to unpaid carers, such as the parents of the people with disabilities he talks about? Last week, the King’s Fund reported that the number of unpaid carers receiving direct support from local authorities fell by 7% from 2020 to 2021. Does he agree that unpaid carers are being failed by this squeeze and the inadequate local authority funding, and that the Government need to do more to improve that and ensure that carers are properly supported?

[Mr Betts]

That is a great point from my hon. Friend. We recognise that that care is generally provided with a lot of love and commitment from people who do it, but very often they will reach breaking point without the additional support from local authorities, such as respite care. Families say to me, “If only I could just have a week where I could go away and relax a bit, knowing the person I am caring for is being looked after, that would make an enormous difference.” Sometimes that does not exist anymore, so that is an important point.

--- Later in debate ---

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

I was not going to speak, but I have been drawn by some of the speeches that I have heard to add some comments, particularly on autistic people and people with learning disabilities and their care. One of the worst aspects of the chronic underfunding of adult social care is that it has led to a reliance on inappropriate in-patient care for autistic people and people with learning disabilities, 2,000 of whom are in that situation. The Government seem chronically unable to get that number down; there have been all kinds of targets to reduce it, but it has not happened.

That care is often expensive and far from home. The hon. Member for North Shropshire (Helen Morgan) told us about people in a care home far from their homes, but when the care is in in-patient units, it is often unsuitable. We know from scandals at units such as the Edenfield Centre, most recently, and Winterbourne View—there have been 10 years of scandals in those in-patient units—that they are frequently found to use restraint and seclusion as a punishment.

There have been inquiries and reports into the level of social care funding, such as that chaired by my hon. Friend the Member for Sheffield South East (Mr Betts), who made an excellent speech. The Health and Social Care Committee, of which I was a member, also looked into the issue and made recommendations. The squeeze on local authority funding means that local authorities feel that they have to put the bill on to the NHS—it becomes easier for a local authority to let the NHS pick up the bill for an autistic person or a person with learning disabilities.

Those placements can cost hundreds of thousands of pounds a year—up to £1 million. In one case that we have spent a lot of time talking about in the House, the NHS was funding a placement that cost £1 million a year. Clearly that makes no sense, because the money could go into housing or care for that person, but there does not seem to be any way to passport the money from the NHS, which is shelling it out every year, to the local authorities that would need it if they were to house and provide care for those people.

However, we had a solution years ago. When people were moved from long-term mental health institutions into the community, a dowry went with them from the NHS to the local authority. When I was the vice-chair of social services as a councillor, if we picked up somebody who had been in a long-term mental health institution to move them to the local authority, they came with a dowry that might be as much as £1 million. If a local authority were to buy a property or pay for care for a number of years, that system would work.

I urge the Minister to look at the recommendations made by the Health and Social Care Committee when we looked at this, but also to take account of what the hon. Member for North Shropshire said about how we cannot leave this in an unsatisfactory and precarious situation. It is good that some solution was found in the case she mentioned, but too often people end up in in-patient care and then will be there for the rest of their lives. There are people in these institutions who have been there 10, 20, 25 or 30 years, and it is tragic, because once someone has spent that long in an institution, it is very difficult to find a way back to the community. I wanted to mention that because it has been raised in the debate.

I want to mention one other thing. The right hon. Member for Ashford (Damian Green) and the hon. Member for North Devon (Selaine Saxby) talked about support and recognition for carers, and they are right to do so. We should all think about how we support unpaid carers. However, I want to say that I think the thing that is missing is that we do not have a proper national carers strategy. The last national carers strategy we had in this country was under the last Labour Government, and it came out in 2008. That would solve the problem, which my hon. Friend the Member for Sheffield South East talked about, of there being no respite care breaks for carers. That national carers strategy had a commitment of £255 million specifically to support carers, including £150 million for respite care breaks. We now find that there is no money we can identify or point to that is specifically for respite care breaks. Given the squeeze on local authority funding, it just does not happen.

What this Government have had is a carers action plan, which is a weak document. The last one, which covered 2018 to 2020, had no funding commitments and was very short of ambition. I know that carers organisations very much campaign for us to go back to having a national carers strategy, which in the case of the Labour Government had the commitment of the Prime Minister and each of the Secretaries of State responsible for services used by carers. I think the key thing, as we have heard in this debate—I really stress this point—is that we have to go back to having some money that is kept separately for respite care breaks for carers, otherwise they will be pushed and pushed, and they will not get the support they need.

I just wanted to speak on those two points, Madam Deputy Speaker, and I join everyone else in saying what a pleasure it is to see you back in your place.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Thank you. I call the shadow Minister.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Levelling Up, Housing and Communities (Lee Rowley)]

I add my voice to all those who have welcomed you back to the Chair in recent days, Madam Deputy Speaker.

I thank right hon. and hon. Members who have spoken in this debate. It has been a good debate that has highlighted some of the challenges, and demonstrated some of the opportunities in this area. I am particularly grateful to my near neighbour and Chair of the Levelling Up, Housing and Communities Committee, the hon. Member for Sheffield South East (Mr Betts). We do not agree on everything, but he had a long and illustrious history in local government before he joined this place, and since then he has taken a significant interest in this subject. I am grateful to him for introducing the debate in such an even-handed manner.

As all those who have spoken today have indicated, this is an important area of policy for a variety of reasons. That is why there is such close working between the Department for Levelling Up, Housing and Communities and the Department of Health and Social Care, given the importance of the issue, the need to get it right, and the need to continue to make progress on some of the challenges that have been highlighted. We have also worked closely to ensure some of the achievements that have come forward in recent years. As hon. Members will know, policy is largely within the Department of Health and Social Care and the funding process, via the local government finance settlement, is within the Department for Levelling Up, Housing and Communities.

I will try to answer the questions as best I can on all the elements that have been raised today. Colleagues raised a substantial number of points that fall into three broad buckets: first, where we are; secondly, where we are going; and thirdly, what we do about the long term. I will take those three points in turn.

First, there is no disagreement across the House that there are challenges, and that there have been difficulties on both a macro level and across government and society as a whole. There are also challenges within adult social care. More broadly, over the past 20 years, under Governments of all parties, we have seen changing demographics. It is great that more people are living longer, but that creates challenges for whoever is on the Treasury Bench to ensure that the Government support people to the extent that they can. There is often greater acuity with individuals in the system, and more have multiple conditions. More broadly, in recent years and despite valiant attempts by the hon. Member for Luton North (Sarah Owen) to gloss over them, we have received the challenges of inflation, of external events and of covid, all of which have created issues across the Government. A mature debate will recognise and acknowledge those challenges, and seek to build on them and resolve them over time.

The hon. Member for Sheffield South East is correct to say that funding has been much questioned over the past 13 years, and we will all have different views on that. The issue has been much discussed since 2010, just as the reasons behind decisions that were taken between 2010 and now have been much discussed. I will not detain the House by repeating those reasons, other than to say that we know them, and that they are at least anchored in a set of decisions that were taken before 2010. It is also important to acknowledge—I hope hon. Members will do this—that significant additional funding has gone in and is going in over the remainder of the spending review period, with £2 billion of additional grants in 2023-24, and nearly £1.5 billion of additional funding in 2024-25. Money is not everything, but ultimately there is a recognition in all parts of the House that there are challenges with adult social care, and more money has gone in.

The hon. Gentleman also talked about the way we fund. Although I accept challenges from right hon. and hon. Members about the right balance, I hope we can agree within our discourse that it is reasonable and proportionate for us to have both funding provided centrally and an element of local funding, not least so that there is linkage between how organisations and local councils decide to spend that money in the locality and how they raise it. As I say, I accept that there are different views about what the proportions should be, but I hope that future discussion of this issue acknowledges the reality and appropriateness of that balance.

Although I am trying not to be too political, it is important to note that some of the challenges have been in place over recent years because there has been a challenge with Government funding over the course of 13 years. We have been trying to keep taxes down for people when we are able to do so. It is important to note that council tax more than doubled under the last Labour Government, and we have spent a significant amount of time and effort in the local government system since 2010 making sure that increases are as low as they can be.

[Barbara Keeley]

The Minister is talking about the balance between funding being found locally and funding from central Government grant. The issue I have outlined is that it would be unreasonable for a local authority to have to find something like £1 million extra. I have talked about placements for people with learning disabilities or autistic people that can cost up to that. That cost is being borne by the NHS, yet it could be much lower if the person had suitable housing found for them in the community. It is not reasonable to expect a local authority suddenly to find a large amount of money if a case comes up. Together with colleagues from the Department of Health and Social Care, will the Minister look at the idea of a dowry that I put forward, so that people do not have to spend 10, 20 or 30 years in horrible NHS institutions that are often far from home and unsuitable? This is just a logistical problem about where the money is, and it seems that of all the problems we could solve, this is one we should be doing something about.

[Lee Rowley]

I am grateful to the hon. Lady for her intervention. I will come to her points in a moment.

I acknowledge the point that my hon. Friend the Member for North Devon (Selaine Saxby) made about rurality, which is one reason why it is important that there is a balanced understanding that some funding is raised locally. Different parts of the country will have different requirements, pressures and challenges, which, in many parts of the country, will include rurality. I accept that that creates an issue in certain places. From a local government perspective, rather than an adult social care perspective, we have tried to acknowledge that, at least in part, in the local government finance settlement through the rural services delivery grant. I am always happy to look at that and to talk to my colleagues in more detail, as we prepare for funding settlements in future years.