Perinatal Mental Illness

Baroness Keeley Excerpts

Thursday 19th July 2018 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Rosindell. I congratulate my hon. Friend the Member for Stockton South (Dr Williams) and the hon. Member for South West Bedfordshire (Andrew Selous) on securing this important debate and on how they opened it. We have heard contributions from the hon. Member for Strangford (Jim Shannon), my hon. Friend the Member for Canterbury (Rosie Duffield), the hon. Member for Bath (Wera Hobhouse) and the Scottish National party spokesperson, the hon. Member for Glasgow Central (Alison Thewliss). We also heard interventions from the hon. Member for Thirsk and Malton (Kevin Hollinrake), my hon. Friend the Member for West Ham (Lyn Brown) and, just a moment ago, my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger).

Pregnancy, birth and becoming a parent can be a special and rewarding time for many people. As we have heard, it is a time to celebrate new life and the start of the exciting journey into parenthood. However, for others, the stress and upheaval of pregnancy and becoming a parent can trigger existing mental health problems or spark new ones. Perinatal mental health issues can include severe mental health disorders that require severe immediate hospital treatment, such as postpartum psychosis. It may affect only two cases in 1,000, but it is a very serious condition and can put new mothers at risk of harming themselves and their baby. The issues can also include most common mental health conditions, such as depression, anxiety, post-traumatic stress disorder, obsessive compulsive disorder and panic attacks. My hon. Friend the Member for Stockton South spoke very well about the impact of those mental health conditions on the child’s development.

Given the expectation that pregnancy and becoming a parent should be a joyful time, women who experience those conditions can feel even more stressed and unhappy, and often that they are somehow to blame for their condition. A study by the Boots Family Trust in 2013 described some of those experiences. One mother said:

“I avoided friends at all costs as I lost the ability to communicate and became very isolated”.

Another said:

“I’m currently into my second pregnancy and think I am suffering from depression…I feel scared and feel like I have trouble bonding with this pregnancy…I don’t know what is wrong with me.”

We know that one in five women will experience mental health problems during pregnancy. Given the high prevalence of mental health issues in new and expectant mothers, the woman I just quoted should not have had to feel like something was wrong with her. We have heard many excellent examples in the same vein in this debate. One way to prevent women from feeling isolated or somehow to blame is by identifying those mental health issues and ensuring the proper support is put in place. Unfortunately, as hon. Members said, too often that does not happen.

Hon. Members rightly highlighted that identification is a major barrier to accessing support for mental health issues. I join them in congratulating the National Childbirth Trust on its #HiddenHalf campaign. The research underpinning that campaign shows that nearly half of all the mental health problems that new mothers experience are not picked up by health professionals.

As we have heard, early intervention is key. The sooner issues are identified, the quicker people can access appropriate support, and that surely drives better outcomes. It is simply not good enough that only half of perinatal mental health issues are picked up. As my hon. Friend the Member for Stockton South detailed, GPs should offer a post-natal check about six weeks after the baby’s birth. We have heard that a properly delivered check-up can have a transformative effect on new mothers who are experiencing mental health problems. Research by the National Childbirth Trust found that women directly questioned by a GP about their mental health were almost seven times more likely to disclose a mental health problem. If mental health problems are left untreated, they can escalate into much more severe mental illness.

The National Childbirth Trust also found that 95% of women who had experienced a mental health problem felt it affected their ability to cope or look after their children or family relationships. As we have heard, the six-week post-natal baby check is mandatory, but the maternal check was left out of the GP contract. As a result, the maternal check is often not done at all or becomes a rushed conversation at the end of the baby check. In one third of cases, the maternal check was estimated to last three minutes or less.

The National Childbirth Trust recommends that the Government fund the six-week maternal post-natal check so that GPs have the time to give every new mother a full appointment for the maternal check. As we have heard, the National Childbirth Trust also recommends an improvement in the guidelines for best practice around maternal mental health, including a separate appointment for that maternal six-week check, and they recommend better methods of encouraging disclosure of maternal mental health problems.

I have looked at the NHS England guidance, which states:

“There are no set guidelines for what a postnatal check for mothers should involve.”

It also states:

“The following is usually offered, though this may vary according to where you live...You will be asked how you are feeling as part of a general discussion about your mental health and wellbeing.”

We can and must do better than that.

I have already mentioned the pressure on women to feel happy after the birth of a child and how mental health issues can lead to their feeling that there is something wrong with them. It can often lead to women putting on a brave face. One woman, responding to the Boots Family Trust survey, said:

“I was terrified to admit to any health professional as I was scared they would take my son away.”

That is exactly the point made by the hon. Member for Glasgow Central and it demonstrates the challenges that GPs face in identifying mental health issues. Merely asking how a new mother is feeling is no substitute for a properly trained staff member identifying mental health issues and knowing how to encourage disclosure.

The National Childbirth Trust recommends that NHS bodies should support and invest in initiatives to facilitate and further develop GP education on maternal mental health. Earlier, my hon. Friend the Member for West Ham touched on the fact that investment in perinatal mental health would result in savings. It is worth thinking about how much that might be.

The statement from the Royal College of General Practitioners about perinatal mental health said that post-natal depression, anxiety and psychosis carry an estimated total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK, and 72% of the cost relates to adverse impacts on the child. That reinforces the very important points that my hon. Friend the Member for Stockton South made earlier. More than a fifth of those total costs—£1.7 billion—are borne by the public sector: mainly NHS and social care. I hope that that all helps to give the Minister ammunition. Sadly, the average cost to society of one case of perinatal depression is estimated to be £74,000: £23,000 relates to the mother and £51,000 to the impact on the child. There is every reason to try to make the case being made in the debate today.

We must make sure that, where a diagnosis has been made, appropriate treatment and support is made available. According to the Maternal Mental Health Alliance, a quarter of pregnant women and new mothers cannot access specialist perinatal mental health services that meet the full National Institute for Health and Care Excellence guidelines. Only 7% of the women who reported experiencing a maternal mental health condition were referred to specialist care. It took more than four weeks for the 38% of the women who were referred to be seen. Shockingly—we have heard several examples—some women waited up to a year for treatment. My hon. Friend the Member for Canterbury talked about such an example. In fact, it was recently revealed that there were only 131 specialist perinatal beds in the whole of the UK, with none in Northern Ireland or Wales.

We know that pressure on mental health trusts comes from money earmarked for mental health services being used to pay for other areas of the NHS. The Labour party would ring-fence mental health spending so that funding for mental health services is not siphoned off to pay for other priorities. In this debate we have heard much detail of the #HiddenHalf campaign. The Opposition support that important campaign and we would look at implementing it in government. We call on the Government now to make resources available so that every mother is given the perinatal support that she deserves. It is important that we also include that commitment to ring-fence mental health spending so that the funding that is meant to be for mental health services does not go to other priorities in the NHS.

The Government have made some commitments on perinatal mental health, and I am keen to hear from the Minister, if we have time, what progress has been made. The five-year forward view for mental health set a target to ensure that by 2021 at least 30,000 more women each year would be able to access specialist mental health care during the perinatal period. Given that we are now halfway through that phase of the five-year forward view for mental health, can the Minister tell the House what progress has been made towards that target and whether NHS England is on track to meet it?

In autumn 2017, at the maternal mental health ministerial roundtable, a number of commitments were made to improve perinatal mental health services. They included a commitment that the Department of Health would work with health system partners and other Government Departments to deliver improvements in perinatal mental health services, and a commitment that NHS England would expand specialist mental health services by 2021 to meet the needs of women in all areas. We have heard, as we hear in so many debates on health and social care, about very unfortunate postcode lotteries, so how is NHS England doing in expanding those specialist services to meet the needs of all women?

[Luciana Berger]

My hon. Friend is making a strong case, as have other colleagues, about the inconsistency of the availability of perinatal mental health services. Although there has been some investment, there are still many areas where there is no sufficient, adequate or indeed any immediate access, and mothers still have to travel too far across the country to access a bed if they need one in a mother and baby unit. Does she share the concern expressed by the British Medical Association that there is a 20% difference in referral rates in some areas, which illustrates the inconsistency of care? When the issue is so critical not only for the mother but for the child in its lifetime, that is something that the Government should urgently address.

[Barbara Keeley]

I absolutely agree with my hon. Friend. It is very important that the Minister tells us now or after the debate what is happening to expand the services so that we do not have what are almost deserts, where women have to travel either to get a bed or to get the service that they need.

Finally, there was a commitment in autumn 2017 that NHS Health Education England would support the roll-out of GP perinatal mental health champions across England. I am sure it would help if there was in every area a perinatal mental health champion speaking up for their own area. Will the Minister tell the House what progress has been made on these important commitments?

I want to conclude on a wider point about women’s mental health. Women are more likely to suffer from mental ill health than men, and yet too often women’s specific mental health needs remain a blind spot. Research by Agenda, the women’s mental health charity, has shown that mental health trusts are too often failing to consider women’s specific needs. Only one of the 35 trusts that responded to a freedom of information request by Agenda had a strategy on gender-specific mental health services.

Fourteen years ago, the Labour Government launched a comprehensive women’s mental health strategy to address the specific mental health needs of women. Sadly, that strategy was ditched by the coalition Government, and women’s mental health has since slipped down the policy agenda. The Mental Health Foundation has described it as being “almost invisible” in Government policy.

We have had an excellent debate today in which many useful examples have been given and many good points made. There is a strong feeling that we want to help the Minister do something about this issue. Will she in future match Labour’s commitment to have a national women’s health strategy that would work to deliver the targeted support that women and girls need?

--- Later in debate ---

[Jackie Doyle-Price]

I agree and do not think the two points are in conflict. We need both—we need the wider package of support.

The theme we have been considering—of women not always being asked about themselves, and its being all about the baby—is not confined to the issue of perinatal mental health. Women face that across the board with respect to their health. The hon. Member for Worsley and Eccles South (Barbara Keeley) spoke about a women’s health strategy and women’s mental health. I co-chair a women’s mental health taskforce with the chair of Agenda, and in the coming weeks we will present our report on a year-long piece of work. It will have information about tools to enable the health service in general better to support women’s mental health. I am also doing more to raise the whole issue of women’s mental health, because I feel strongly that women are often disempowered in health settings. We need to give them the tools to take control of their own care and to feel empowered to engage in good conversations with medical professionals, to benefit their health.

We have heard anecdotal accounts of women’s experiences, and what has come across is the arrogant behaviour of some medical professionals. They see a large number of patients and they are not always sensitive to how best to communicate with certain individuals. We need that practitioner-patient relationship to work a lot better, particularly in the case of women. I am open to representations from everybody about what tool we can use.

The hon. Member for West Ham (Lyn Brown) is no longer in her place, but I have been impressed by her work on hysteroscopies with women. We are developing tools on that. I reassure all Members that women’s health and the way in which the national health service can better serve women are high on my agenda. I am not going to stand here and say that the world is perfect, but we have made perinatal mental health a priority in the five year forward view. We are midway through that review, so I should give Members an account of how far we have got and what more needs to be done.

To go back to 2010, the situation was really quite poor. Only 15% of localities had fully fledged specialist services in the community, and 40% of communities provided absolutely no service at all. People talked about a postcode lottery; clearly, we could not allow that to continue. We need to work towards universal provision. We are implementing the recommendations of the five year forward view for mental health taskforce, which reported in 2016. From 2015 to 2021, we are investing £365 million into perinatal mental health services. NHS England is leading a transformation programme to ensure that, by 2021, at least 30,000 more women each year are able to access specialist mental healthcare during the perinatal period. In May, NHS England confirmed that, by April next year, new and expectant mums will be able to access specialist perinatal mental health community services in every part of the country. We are making progress. The key to that is community provision.

[Barbara Keeley]

I asked the Minister a specific question: we are halfway towards the deadline for the 30,000 target—does she know how that target is going? Has there been an improvement of 15,000?

[Jackie Doyle-Price]

I will write to the hon. Lady with some detail on the figures, but the point is that the access is there. Obviously, it will take time to become embedded. We have a good direction of travel to deliver against that commitment and we will continue with that. Community-based provision is key, but we also need to ensure that there are sufficient specialist perinatal mental health beds in mother and baby units for particularly severe cases. NHS England has taken a more strategic approach to commissioning, so that there is a level of access that does not involve wide-scale moving out of area.

As ever with transformation programmes, change takes time, but we are on track to meet our commitments. We are investing £63.5 million this financial year to support the development of those specialist perinatal mental health community services across England. Our pace of change is to enable 2,000 more women to access specialist care. Last year that was exceeded, so we should maintain the pace that we planned in the five-year forward view.

I have visited one of the new in-patient mother and baby units in Chelmsford, where there are four new beds. That centre is expanding its capacity. As well as opening new centres, we are expanding the capacity of existing ones to give more support. In Devon, the trust opened a four-bed mother and baby unit in a reused space in April this year while the new unit is being built, so we still have that provision even though there is not the physical space. By the end of this financial year, we will have expanded the capacity of those beds by 49% since 2015 and there should be more than 150 beds available for mothers and babies in those units.

We are also expanding psychological therapy services, which successfully treat many women who experience common mental health conditions such as depression and anxiety disorders during the perinatal period. We have set an ambition for at least 25% of people with common mental health conditions to access services each year by 2020-21, including extending provision to ensure swifter access for new and expectant mothers. However, as we have heard today, getting perinatal mental healthcare right is not just about expanding specialist services in isolation. Many professionals in different parts of the health and care system are well placed to support women in the perinatal period. NHS England is working with partners to ensure that care for women is integrated and joined up effectively. More than £1 million was provided in 2017 to enable the training of primary care, maternity and mental health staff, to increase perinatal mental health awareness and skills.

NHS England has also invested in multidisciplinary perinatal mental health clinical networks, which will include GPs across the country to support that strategic planning, working across services to ensure that those wider services are in place. The role of GPs is central in identifying when someone is suffering from perinatal mental illness, and to ensure that those women are directed towards treatment. The role includes monitoring early-onset conditions, including pre-conception counselling, referring women to specialist mental health services, including access to psychological therapies, and specialist perinatal community teams where necessary.

I am aware of the NCT’s #HiddenHalf campaign; I am grateful for its campaigning on this important issue. The National Institute for Health and Care Excellence recommends post-natal checks for mothers and new-born babies. NHS England expects commissioners and providers of maternity care to pay due regard to the NICE guidelines. My hon. Friend the Member for South West Bedfordshire raised this issue and said that, since this was part of what we should expect from GPs, it seemed anomalous that so many mothers and babies were not getting such checks. We make clear to GPs what we expect of them, as part of their contract, but ultimately we rely on clinical commissioning groups to ensure that GPs deliver against the obligations that we expect of them. This is not the only case where this happens—many GPs are not delivering learning disability health checks either. We need to be clear with NHS England that we expect that obligation to be delivered.

--- Later in debate ---

[Jackie Doyle-Price]

I was coming to that—I was just dealing with the point made by my hon. Friend the Member for South West Bedfordshire.

Moving on from the NICE guidelines, we clearly expect GPs to do their part in identifying and supporting women. We are aware of the campaign, but any changes to GP contracting arrangements to specifically include the six-week check-up would need to be negotiated with the GP committee of the British Medical Association. Those negotiations are taking place and will be completed by September. I cannot give any firmer commitment than that, other than to say that we obviously want to see GPs make their contribution.

[Barbara Keeley]

I just want to reiterate what I said earlier: the Opposition support that campaign and would look at implementing it in government. I outlined that the NCT put a cost of £20 million on it. Clearly, the Minister could have that figure checked out, but it is balanced against the £1.2 billion extra cost to the NHS and social care of perinatal mental health problems in every one-year birth cohort. There really is a point here about investing to save further down the road.

[Jackie Doyle-Price]

I thank the hon. Lady for that. As she says, if we are talking about £20 million in a broader settlement, that clearly should be under consideration given the outcomes that could be achieved on the basis of the evidence we have seen. I am not negotiating the contract, but we will have the outcome of those negotiations in the not-too-distant future. Members on both sides of the Chamber expressed very clearly the view that they want GPs to be able to do more to support new mothers. That message has been well noted, and I thank Members for making it. They said they wished to give me as much as assistance as they could in my battles on these things, and they certainly made a very strong case.

I want to come back to health visitors. I am a firm believer that health visitors are uniquely placed to identify mothers who are at risk of suffering, or are suffering, perinatal mental health problems and to ensure they get the early support they need. In fact, I visited the Institute of Health Visiting only a couple of weeks ago and heard a moving story from a new mum who had gone through a mental health crisis. It is striking that she had experienced all the feelings we have talked about—she felt there was something wrong with her, she could not bond with her baby, and she got more and more depressed and withdrawn about it. The other interesting thing about that case was that it was dad who felt utterly powerless to do anything. Only their relationship with their health visitor enabled them both to reach out for help.

I am under no illusions about the importance of health visitors. I was privileged to meet so many fantastic advocates for them as part of the NHS’s 70th birthday. They are our eyes and ears in so many ways, and they are our intelligence network in tackling adverse childhood events. I am full of praise for the important job they do in supporting new parents and families through a child’s early years. I am really pleased about the success of the Institute of Health Visiting perinatal and infant mental health champions training programme. Those 570 champions play a crucial role in spreading good practice and early identification of mental health problems.

Some hon. Members raised concerns about the decline in the number of health visitors. There was a substantial increase in the run-up to 2015, and there has been a fall since. I am bothered about that, so I will look at how we can encourage local authorities to alter that situation, recognising that in some areas local leaders have realised that health visitors can do so much more to deliver better outcomes for their communities. Blackpool, for example, has substantially increased the number of visits. I am really looking forward to seeing the outcome of that work, so that we can encourage that good practice in other local authorities.

I reiterate my thanks to all Members for their thoughtful comments and questions, but I especially thank the hon. Member for Stockton South and my hon. Friend the Member for South West Bedfordshire for securing the debate. I am very proud of our direction of travel in delivering and transforming perinatal mental health services so that we ensure that more expectant and new mothers are able to access high-quality mental health support, but we should never be complacent about that. I look forward to continuing the transformation programme.

Department of Health and Social Care and Ministry of Housing, Communities and Local Government

Baroness Keeley Excerpts

Monday 2nd July 2018 Commons Chamber

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

As hon. Members have said, today’s debate comes in the week of the national health service’s 70th birthday. It is fitting that we should celebrate the NHS, which is one of this country’s most cherished organisations, but this week also marks another less-celebrated 70th birthday: that of social care. It is only right that we recognise the vital role that social care plays in keeping people independent and in supporting them with daily activities. Many hon. Members focused on social care in their contributions, but it is in a worrying state of decline at a time when it has never been more needed.

The joint report by the Health and Social Care Committee and the Housing, Communities and Local Government Committee, which is chaired by my hon. Friend the Member for Sheffield South East (Mr Betts), described a system

“under very great and unsustainable strain.”

The report found that the care system is not fit to respond to current needs, let alone to meet future needs. The Association of Directors of Adult Social Services said in its most recent budget survey earlier this month that the present situation “cannot go on”. The King’s Fund says that progress is “desperately needed” and that the system needs an urgent injection of cash just to maintain things as they are.

The projected growth in demand for services from our ageing population, with its ever more complex care needs, is set to rise substantially. I ask the hon. Member for Mid Worcestershire (Nigel Huddleston) to look at the years of healthy life expectancy, which end in someone’s 50s or 60s in many deprived areas. At the current rate of spending, the system will face a funding gap of £2.2 billion to £2.5 billion by 2019-20, and as we have heard, grant funding from central Government to the budgets of councils that have a statutory responsibility for delivering care has been cut by around 40%. As we heard from my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), the budget has been cut by 60% in Liverpool.

As the Select Committees’ report notes, local authorities have also faced other cost pressures, such as the apprenticeship levy, increased national insurance contributions and the so-called national living wage, which has had the most significant impact. Cost and demand pressures on councils are growing, but ADASS reports that £7 billion has been cut from adult social care budgets since 2010. With the Government’s Green Paper now delayed until the autumn, a funding settlement for social care sadly does not seem imminent. According to ADASS, recent Government funding simply is not keeping pace with demand, and the result is that councils are plugging the gap in any way they can. Over half of local councils are unsustainably raiding council reserves, while others are making cuts elsewhere, so other important council services suffer. Local authorities, to their credit, are doing their best to protect budgets for adult social care services, but the increasing financial pressure on councils has meant that both the quality and the sufficiency of care have fallen and are anticipated to fall further.

Care providers’ dependency on dwindling local authority fee levels is leading to the care market becoming increasingly fragile and even failing in some parts of the country. A recent report from Age UK described the emergence of “care deserts” where care is wholly unavailable. Forty-eight directors of adult social services report that they have seen care providers closing or ceasing to trade in the past six months, 44 have had contracts handed back by homecare providers and 58 have seen care or nursing home closures, involving 2,000 people, with 135 care homes ceasing to trade in the past six months—this is from my hon. Friend the Member for Crewe and Nantwich (Laura Smith)—which is more than five a week.

Care homes with predominantly council-funded placements are at most risk of failure. Indeed, some care providers are now rejecting local authority-funded placements because of that funding shortfall. Continued failures of that type would be disastrous for publicly funded care, because councils would have to find care placements with a shrinking pool of providers.



As we have heard, the most serious imminent threat to the viability of the care sector is the unresolved sleep-in care back pay crisis, which my hon. Friend the Member for Crewe and Nantwich referred to comprehensively. As she said, this issue has been going on for several years since a tribunal ruled that overnight care shifts should be paid at the national minimum wage, rather than at a flat rate. Care providers, mainly charities, are facing a six-year back pay bill, which many say they cannot afford without having to withdraw services or close altogether. In a recent survey, 70% of learning disability social care providers said they would cease to be viable if they had to pay this bill. As hon. Members have said, this issue has been handled badly.

Having admitted that previous guidance to care providers had been misleading, Ministers seem to be continuing to ignore warnings that the combined liability of providers —some £400 million—could cause the collapse of parts of the care sector. Perhaps even worse, an estimated 100,000 personal budget holders will be liable to pay thousands of pounds in backdated pay. I join other hon. Members in saying that I hope the Care Minister will tell the House what plans are in place in the event that those care providers go to the wall and what help there will be for personal budget holders.

As we have heard, the Government seem to have no grasp of the urgency of this problem, which could derail the Transforming Care programme and could see large numbers of the most vulnerable people go without care services. Where people are able to get care, it is not always of the best quality. A fifth of care facilities have the worst Care Quality Commission rating. I am concerned that worrying pockets of poor quality are now emerging across both residential and home care, particularly in the north-west and the north-east, with nursing care among the worst affected.

I recently met a group of care staff from different parts of the country, and some of their stories of their current work experience are horrifying. Overworked, underpaid and undervalued care staff are under pressure as never before. Care providers are trying to meet increased demand for care with diminishing fee levels and are even reducing care packages to win procurement bids in the horribly named “reverse auctions.” That has led to staff with many years’ care experience being stuck on zero-hours contracts, with the constant threat of extra hours of work being withheld.

Staff are turning up to work ill because they are not paid sick leave or because they fear having their pay docked. Young apprentices are being left in responsible care positions for which they have no training or experience. Most troubling was to hear of lists showing staff on care rotas when they are actually on long-term sick leave or maternity leave, or rotas including managers and staff who do not provide care.

It is only the experience, dedication and devotion of care staff such as those I met that has stopped care quality sliding even further. The CQC has warned that the resilience of care staff is not inexhaustible. Under such pressure, with no training and little support, the recruitment and retention crisis will get worse.

We know that the impact of cuts to social care budgets is most keenly felt by people who need care and their families, and we know that 1.2 million older people who need social care have unmet care needs. People are not getting the help they need with the basic tasks of daily living, which is robbing them of their dignity. The fragility of the care system is also heaping great pressure on many unpaid carers who have to pick up the slack when formal care is unavailable. Carers are coming under unprecedented pressure, with little opportunity for respite, because most councils now have to charge for care breaks, as Labour research has shown. Four in 10 carers have not had a day off in a year, while one in four unpaid carers have not had a day off in five years. That is taking a heavy toll on their health; almost three quarters of carers told Carers UK that they had suffered mental ill health as a result of caring, while well over half said their physical health had worsened.

Despite the great contribution that carers make to the economy, the Government’s recent carers “action plan”, published in place of a promised national carers strategy, sadly offered no financial commitments to increase support for carers or to increase carer’s allowance, which is still less than jobseeker’s allowance. That is an insult to people whose care is estimated to be worth over £130 billion per year to the economy.

NHS sustainability depends on an effective and properly funded social care system. As we have heard in this debate, there was no money for social care in the Prime Minister’s recent NHS announcement. The announcement also excluded public health budgets, at a time when childhood obesity is reaching epidemic levels, and when there have been cuts to sexual health and addiction services. Just as with social care, underfunding those important preventive services is a false economy and will end up costing the NHS. There is now broad agreement that the need for investment in social care has never been more urgent and doing nothing is not an option, yet all we have from this Government is a proposed Green Paper, now delayed until the autumn, setting the timetable for dealing with the funding crisis in social care back even further.

I want to say in conclusion that that is not good enough. Social care needs funding now to ease the crisis and to stabilise the care sector. It is time this Government showed leadership and acted in the best interests of all the people across the country who need care.

Adult Social Care: Long-term Funding

Baroness Keeley Excerpts

Thursday 28th June 2018 Commons Chamber

[Mr Betts]

I thank the hon. Lady, the Chair of the Health Committee—I think on this occasion, my hon. Friend, because we have worked on a friendly basis on this inquiry. She is absolutely right. One of the important recommendations is about trying to extend the scope of care provision to include those with moderate needs. If we provide care for them, it is quite likely that we will stop them getting into the substantial and critical phase and ending up in hospital in the first place. In terms of the NHS, it is about stopping people getting into hospital by getting them proper care and having care available for people in hospital, so that they do not have delayed discharges. In those two ways, that can be beneficial. Of course, we can also join up services. Can the NHS district nurse who goes into someone’s home and looks at their needs not assess their care needs at the same time? Can we not get that sort of joined-up approach?

It was remiss of me not to thank the staff, as the hon. Lady did, and I will name Laura and Tamsin. The work they did on this was exceptional. To produce a report of this quality in the time available was absolutely first-class, and we should congratulate them on it.

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

I thank the Chairs and the members of the Select Committees for their work on the report, and my hon. Friend the Member for Sheffield South East (Mr Betts) for his statement introducing it. The key points from the report for me are that in its present state the care system is not fit to respond to current needs let alone predicted future needs, and that spending on social care needs to rise. Next week is the 70th birthday of social care, as well as of the NHS, but there is no funding settlement and no celebrations for social care. Does my hon. Friend agree that the time for a funding settlement for social care is now or at least soon, not years down the road?

[Mr Betts]

Yes, I completely agree with that. We have got to get on with it. If we agreed everything now, it would probably take two or three years to put it in place. That is why we suggested the stop-gap measure of the extra business rates in 2020 being made available for local authorities. We thought that was a very important solution. If we get it right, we can have stability for the long term. The Germans did this over 20 years ago. They have a stable system and it works. They have just put extra money into it with general public support, because everyone trusts the system. That is the position we have to get to.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 19th June 2018 Commons Chamber

[Mr Hunt]

I thought that the report made powerful reading, and I know that my hon. Friend was associated with it. Yesterday the Prime Minister was straightforward about the fact that, if we are to preserve our NHS and make it one of the best systems in the world, the burden of taxation will need to increase, and she was willing to listen to the views of colleagues about the most appropriate way in which that should be done.

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

The Association of Directors of Adult Social Services has reported a £7 billion reduction in adult social care funding since 2010, and Age UK has reported there are now “care deserts” in some parts of the country. There are 1.2 million older people living with unmet care needs, and one in five care services has the poorest quality ratings from the Care Quality Commission.

As well as a long-term funding solution for social care, we need the extra £1 billion this year and £8 billion in the current Parliament that Labour pledged before last year’s general election. However, all that the Government offer is a delayed Green Paper. When will the Secretary of State deal with the current crisis in social care?

[Mr Hunt]

No, that is not correct. Yesterday we made very clear our support for the social care system and our recognition that reform of the NHS must go hand in glove with the social care system, and we said there would be a new financial settlement for the social care system. It is also time that the Labour party took some responsibility for the financial crisis that made all these cuts necessary.

Health and Social Care

Baroness Keeley Excerpts

Wednesday 9th May 2018 Ministerial Corrections

The following is an extract from the Urgent Question answered by the Minister of State for Care on 8 May 2018.

[Barbara Keeley]

The Secretary of State announced to the House in December 2016 that he would ask the review for annual reports on its findings, so why was a review of this importance published during the recess, before a bank holiday weekend in the middle of local election results, giving Members little chance to scrutinise its findings? When asked about the report on the “Today” programme on Radio 4, Connor Sparrowhawk’s mother, Dr Sara Ryan, said that she was

“absolutely disgusted by the report”

and that the way it had been published at the beginning of a bank holiday weekend

“shows the disrespect and disregard”

there is for the scandalous position of people with learning disabilities shown in the report.

[Caroline Dinenage]

On the date of publication, the hon. Lady will be aware that this was an independent report prepared by the University of Bristol and commissioned by NHS England, which wanted to look into this really important issue, and because it was an independent report, it did not actually alert us to publication, so we had no more notice than she did. We are investigating through NHS England and others why that happened. [Official Report, 8 May 2018, Vol. 640, c. 546.]

Letter of correction from Caroline Dinenage:

An error has been identified in the answer given to the hon. Member for Worsley and Eccles South (Barbara Keeley) on 8 May 2018.

The correct answer should have been:

Learning Disabilities Mortality Review

Baroness Keeley Excerpts

Tuesday 8th May 2018 Commons Chamber

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

To ask the Secretary of State for Health and Social Care to make a statement on the learning disabilities mortality review. [Interruption.]

[Mr Speaker]

Order. There is a certain amount of chuntering from a sedentary position. The Secretary of State has been with us, but Minister Caroline Dinenage will answer the urgent question, and we look forward to her answer.

[The Minister for Care (Caroline Dinenage)]

The Government are absolutely committed to reducing the number of people with learning disabilities whose deaths may have been preventable and have pledged to do so with different health and care interventions. The learning disabilities mortality review programme was established in June 2015; it was commissioned by NHS England to support local areas in England to review the deaths of people with a learning disability. Its aims were to identify common themes and learning points, and to provide support to local areas in their development of action plans to take forward the lessons learned.

On 4 May, the University of Bristol published its first annual report of the LeDeR programme, covering the period from July 2016 to November 2017. The report included 1,311 deaths that were notified to the programme and set out nine recommendations based on the 103 reviews completed in this period. The Government welcome the report’s recommendations and support NHS England’s funding of the programme for a further year at £1.4 million. We are already taking steps to address the concerns raised, but the early lessons from the programme will continue to feed into our work, and that of our partners, to reduce premature mortality and improve the quality of services for people with learning disabilities.

[Barbara Keeley]

Mr Speaker, I think it is disgraceful that the Secretary of State has just run out of the Chamber, rather than answering this question himself—it is disgraceful.

Seven years after Winterbourne View and five years since the avoidable death of Connor Sparrowhawk, the findings of the review show a much worse picture than previous reports about the early deaths of people with learning disabilities. One in eight of the deaths reviewed showed that there had been abuse, neglect, delays in treatment or gaps in care. Women with a learning disability are dying 29 years younger than the general population, and men with a learning disability are dying 23 years younger. Some 28% of the deaths reviewed had occurred before the age of 50, compared with just 5% of the general population who had died by that age.

The Secretary of State announced to the House in December 2016 that he would ask the review for annual reports on its findings, so why was a review of this importance published during the recess, before a bank holiday weekend in the middle of local election results, giving Members little chance to scrutinise its findings? When asked about the report on the “Today” programme on Radio 4, Connor Sparrowhawk’s mother, Dr Sara Ryan, said that she was

“absolutely disgusted by the report”

and that the way it had been published at the beginning of a bank holiday weekend

“shows the disrespect and disregard”

there is for the scandalous position of people with learning disabilities shown in the report.

Only 103 of 1,300 cases passed for review between July 2016 and November 2017 have been reviewed. That is a paltry number. The report cites a lack of local capacity, inadequate training for people completing mortality reviews and staff not having enough time away from their duties to complete a review.

If there are issues around capacity and training, what is NHS England doing to rectify this? Sir Stephen Bubb, who wrote the review into abuse at Winterbourne View, said this in response to the report:

“there can be no community more abused and neglected than people with learning disabilities and their families. How many more deaths before we tackle this injustice?”

Dr Sara Ryan said:

“things have actually got worse than they were 10 years ago”.

What action will the Government take to show the families of people with learning disabilities that their relatives’ lives do count?

[Caroline Dinenage]

I thank the hon. Lady for raising this issue; the report makes for very troubling reading.

On the date of publication, the hon. Lady will be aware that this was an independent report prepared by the University of Bristol and commissioned by NHS England, which wanted to look into this really important issue, and because it was an independent report, it did not actually alert us to publication, so we had no more notice than she did. We are investigating through NHS England and others why that happened.[Official Report, 9 May 2018, Vol. 640, c. 8MC.]

As the report clearly identifies, there is still more work to do, and we will work with partners to see how the recommendations may be implemented. We are committed to learning from every avoidable death to ensure that such terrible tragedies are avoided in the future. She mentions Dr Sara Ryan, whose son, Connor Sparrowhawk, died in such tragic circumstances in my own Southern Health Trust area. She and other parents like her are testimony to the incredible dedication of people who have worked so hard to get justice for their loved ones at a time when they feel least able to do so.

We have done several things already. We have introduced a new legal requirement so that from June every NHS trust will have to publish data on avoidable deaths, including for people with a learning disability, and provide evidence of learning and improvements. We are the first healthcare system in the world to publish estimates of how many people have died as a result of problems in their care. Learning from the review is also informing the development of the pathways of care published by NHS England and the RightCare programme, which is tailored to the needs of people with learning disabilities. Pathways on epilepsy, sepsis and respiratory conditions will be published later this year.

We have introduced the learning disability annual health checks scheme to help ensure that undiagnosed health conditions can be identified early. The uptake of preventive care has been promoted and improved, while the establishing of trust between doctors and patients is providing better continuity of care. We have also supported workforce development by commissioning the development of learning disabilities core skills education and training framework, which sets out the essential skills and knowledge for all staff involved in learning disability care.

As I said, the report makes for troubling reading, but we asked NHS England to commission it so that we might learn from these deaths and make sure that trusts up and down the country are better equipped to prevent them from happening in the future.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 8th May 2018 Commons Chamber

[Mr Hunt]

My hon. Friend makes an important point: unless we make it easier for trusts to retain the receipts of property transactions, they will be likely to sit on these properties and we will not get the positive ideas such as that suggested earlier by the hon. Member for Ilford South (Mike Gapes), so we do need to find a way to make sure that local areas benefit when they do these deals.

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

The Alzheimer’s Society estimates that at least 10,000 people with dementia have been stuck in hospital in the last year despite being ready to leave, and many of the delays were caused by a lack of care in the community for them. There can be no more disorientating thing for a person with dementia than being stuck in hospital when they do not need to be there. So with dementia awareness week approaching, is it not time for the Secretary of State to meet the social care needs of people with dementia fully by meeting the funding gap for social care in this Parliament?

[Mr Hunt]

Let me explain what is happening on that front. In the first five years after 2010, social care funding went down by 1.3% a year—we had a terrible financial crisis that we were trying to deal with—but since then, in the current spending review period, it is going up by 2.2% a year, which is an 8% real-terms increase over this spending review period. I completely agree with the hon. Lady that we need to do a much better job. [Interruption.] Opposition Members talk from a sedentary position about priorities; our priority has been to get this economy on its feet so that we can put more money into the NHS and social care system, and that is what will continue to happen under a Conservative Government.

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.

Social Care

Baroness Keeley Excerpts

Wednesday 25th April 2018 Commons Chamber

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

I beg to move,

That this House notes that Government cuts to council budgets have resulted in a social care funding crisis; further notes that Government failure to deal with this crisis has pushed the funding problem on to councils and council tax payers and has further increased the funding gap for social care; is concerned that there is an unacceptable variation in the quality and availability of social care across the country with worrying levels of unmet need for social care; and calls on the Government to meet the funding gap for social care this year and for the rest of this Parliament.

It has been six months since the House called on the Government to commit the extra funding needed to ease the crisis affecting social care—six months of missed opportunities for the Government to bring more stability to our fragile social care system; six months in which the situation has deteriorated further. The care of older people and of younger people with disabilities seems sometimes to be an afterthought for this Government. The Secretary of State finally made a speech about social care in March, having had the words “social care” added to his title two months previously. Indeed, he told a conference of social workers:

“We need to do better on social care”.

This Government have had eight years to do better on social care.

The simple fact is that since 2010, things have got manifestly worse. I told the House in October that the care system, in the words of the Care Quality Commission, remains at a “tipping point”. Eight years of cuts to council budgets has meant that over £6 billion has been lost from social care budgets since 2010. The diminishing care fees that councils are able to pay in the light of those cuts have further destabilised the care sector, which is already described by the Association of Directors of Adult Social Services as “perilously fragile”.

ADASS reported last year that two thirds of councils had seen care providers close in their areas and that more than 50 councils had contracts with care providers handed back to them. A major chain of care homes, Four Seasons, recently ran into financial trouble, bringing with it the threat of care home closures and uncertainty for thousands of vulnerable elderly people. A few days ago, Allied Healthcare, one of the country’s biggest providers of home care, announced that it would be seeking a financial rescue plan from its creditors. Allied Healthcare has contracts with 150 councils and it cares for over 13,000 older and vulnerable people, so the Minister needs to tell the House how local authorities will be able to discharge their statutory duty to deliver care if Allied Healthcare collapses.

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

On local authorities, my hon. Friend will know as well as I do that because of the cuts to local authority budgets, there is, on the one hand, bed blocking in hospitals, because local authorities do not have enough social workers to prepare a care package, and on the other, when people can go into care, care is so expensive that they cannot afford it. Councils are under pressure to try to make up the shortfall, which they cannot do.

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[Barbara Keeley]

Indeed they cannot, and given the fragility in some of these private care providers, I wonder what on earth councils are supposed to be able to do.

[Norman Lamb (North Norfolk) (LD)]

Does the shadow Minister agree that Allied Healthcare looks like the tip of the iceberg? So many care providers are contemplating getting out of the publicly provided social care market or have already done so that we run the real risk of drifting towards a situation in which people with money can get good care privately but those who do not have the money could be left without.

[Barbara Keeley]

That is almost the situation we are in at the moment. It is worth thinking about why we seem to have this issue with Allied Healthcare, given that the problem has occurred in the last few days. It was reported that Allied Healthcare’s cash-flow problems had been triggered by increases in the national minimum wage for care staff and by an £11 million bill for back pay owed to sleep-in care staff. However, Allied Healthcare is not the only provider that is facing a large back-pay bill for care workers on shift. Learning disability social care providers have warned that they will have to withdraw services or close altogether to pay the bill for back pay, placing the care of even more people in jeopardy and putting care staff jobs at risk.

This trend of closures and contract cancellations is set to continue. A recent report into residential care by the Competition and Markets Authority painted a bleak picture of the current care home market.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

I recently met Lifeways Group, which looks after thousands of people with learning disabilities and has many hundreds of staff who do sleep-in shifts. It pays above the national living wage and is a good employer, but it cannot afford the back-pay claims if the finding goes against it. Should the Government not provide the funding to support these organisations?

[Barbara Keeley]

It is reported, in fact, that the total back-pay bill across the social care providers that provide sleep-in cover will be about £400 million, so it is not surprising that a care provider such as Lifeways would say that. The Government have to come up with answers for this, because there has been a dragging of heels, the guidance has been very confusing, and it is a serious matter. I understand, too, that the Government have completed two reports, but they have not been made public. Hon. Members and I would certainly welcome having those reports placed in the Library so that we can get that information.

We have seen warnings from the Competition and Markets Authority that care homes would find themselves having to close or move away from local authority-funded care because the funding is now only just covering day-to-day running costs. It is quite clear from all this that there is a growing funding gap in social care that must be filled. The Local Government Association has said that our social care system needs an immediate injection of £1.3 billion to fill that gap, and this is projected to rise to £2.5 billion by 2020, according to the King’s Fund.

In our last Opposition day debate on social care, in October, the strain social care was under—from the weight of growing demand, reducing supply and the lack of funds from Government—was plain to see, but since then the system has cracked still further under the pressure of Government funding cuts.

[Thelma Walker (Colne Valley) (Lab)]

When elderly people fall, they often have a stay in hospital, putting additional pressures on the NHS, and when they are ready to be discharged, hospitals sometimes cannot discharge them, because local social care provision is not available. Two thirds of admissions to hospitals for falls could have been averted by early intervention in the home. Does my hon. Friend agree that we need more money for our adult social services?

[Barbara Keeley]

I do absolutely—and that is the point I was making. It was only when the number of delayed transfers of care hit a record high that the Government started to pay much attention to this issue. The other worry is that, as the British Red Cross has reported, in attempting to reduce the number of delayed transfers of care, hospitals often eject people before they are ready. One can see a vicious cycle of admission and readmission.

As I was saying, the system is beginning to crack. Hard-pressed councils and their associations are pleading for more funding to deal with the ever-increasing demand for social care. In December, the former president of ADASS, Margaret Willcox, said:

“The crisis facing us is so acute that we fear social care could pass the point of no return in 2018 while we wait for decisions to be made.”

The National Audit Office has warned that councils could face insolvency after using their reserves just to meet those increasing costs of social care. As well as Northamptonshire County Council being technically insolvent, we recently learned that Worcestershire County Council has a massive budgetary disparity. A report from the Chartered Institute of Public Finance and Accountancy has warned the council that it faces a £26 million hole in its finances this year and that that would rise to £60 million in 2020, owing mainly to an increase in demand. The council chief executive, Paul Robinson, has said that

“there comes a point where cost-cutting can’t go any further – there has to be a solution, and I think it has to be a national solution.”

Lord Porter, the Conservative chair of the LGA, has said to councils that:

“you can’t keep dipping into your savings; sooner or later the money will run out.”

Let us think about what these cuts to social care mean for the quality of care that people receive. In the recent words of the Secretary of State himself, there is unacceptable variation in the quality of services. One in five care facilities receives the lowest quality rating from the Care Quality Commission, and Labour’s own research has revealed that over 3,000 care facilities that already have the lowest quality rating continue to receive the lowest rating even after being re-inspected. Cuts mean providers have less money to pay staff or to invest in training or building renovations, which can obviously lead to their getting trapped in a cycle of poor-quality care provision, and that poor-quality care has a serious impact on the lives of people who need care.

[Kate Green (Stretford and Urmston) (Lab)]

I am grateful to my hon. Friend for pointing out the very high percentage of care homes being found to be inadequate or requiring improvements—the figure is over 40% in my local authority. Does she agree that in many cases this is about care not being safe in those care settings? The real worry is not just that the settings are a bit grotty but that the care is unsafe.

[Barbara Keeley]

Yes, indeed. My hon. Friend takes me ahead in what I was going to say, but I know she has been involved with Age UK in understanding the state of care in her own local area, and I applaud her for that. Cuts have resulted in providers giving poor-quality care, and that is having a serious impact on the lives of people who need care. It means people not being washed or going hours without receiving a meal or being given a drink; it means people being left without help to go to the toilet; and in some cases, as she just said, it means people not being given crucial medication.

Care quality has become so bad that Age UK’s recent report was entitled, “Why call it care when nobody cares?” Many Members went to the launch of the report and listened to the older carers who were there. The anger of those older carers who spoke at or attended the event was palpable. Some told me that they and their families were often at breaking point, that they felt betrayed by a system of care that left them with little or no affordable support, and that they faced rising care costs which they described as crippling, although the care for which they paid was often not good enough.

I know that the Minister was present at that event. She may have talked to one carer there, Elaine from Northamptonshire, whose council is battling insolvency. Elaine gave up her job to care and has cared full-time for her husband ever since, but rather than giving her any extra help, the council recently tried to increase the weekly cost of care support at home from £88 to £178 per week. That was another battle for a carer to fight to obtain the care support that she needed at a price that she and her husband could afford.

Labour Members recognise that unpaid family carers need more support. We understand how much families are doing to look after their family members, and how hard that is for many carers but the Government have not even developed an updated national strategy for carers, having scrapped the planned strategy back in October. Since then, they have even failed to publish the action plan that was promised for January. What does that say about their attitude to carers?

[John Redwood (Wokingham) (Con)]

The motion states that

“there is an unacceptable variation in the quality and availability of social care”.

Where in the country does the hon. Lady think it is really good at the moment?

[Barbara Keeley]

It tends to be outstanding in the independent sector. Charities in particular can be outstanding, although they are not always so.

The care sector’s funding crisis also has an impact on the growing number of people who need care but are given none at all. More than 1.2 million people are now living with unmet care needs, many of them isolated and lonely, and that number rises to 1.5 million with the addition of people who need assistance with taking medication. Unmet needs can lead to people being forced to wear incontinence pads overnight because there is no one to help them to get to the toilet, which takes away their dignity. The number of older people living with unmet care needs will inevitably rise without an injection of new funding, because of the growing demand for care in our ageing population.

It is clear that the social care system needs sustainable funding from central Government, but the Government’s response to the crisis so far has been to push the funding problem on to hard-pressed councils and council tax payers through the social care levy. The only increase in Government funding has been the paltry £150 million extra for social care in the local government finance settlement. That is nowhere near enough to avert the crisis that the Government have created in social care. Moreover, it was not the new money that councils desperately needed. The Government admitted that the increase would be funded through an expected underspend in existing departmental budgets.

It is clear that local authorities are now facing some of their greatest challenges just to make ends meet. I want to highlight the heroic efforts of Labour councils to protect adult social care in the face of swingeing budget cuts from the Government.

[Yasmin Qureshi (Bolton South East) (Lab)]

My hon. Friend has referred to Labour councils. In each of the last two years, my local authority, Bolton Council, has had to increase its council tax rates by 3% and 2% respectively in order to fund social care, and it will have to increase them next year as well. It has had a shortfall of £6 million, and has been able to cover it only by increasing council tax, which is really not acceptable.

[Barbara Keeley]

Indeed. As I have said, the Government have pushed the problem on to councils, which have been forced to use their reserves, and pushed the council on to council tax payers, who have had to pay the levy.

I was talking about the heroic efforts of some councils. Despite budget cuts, which are now running at between 40% and 50%, my local authority, Salford City Council, and neighbouring Manchester City Council have acted to ensure that care providers with which they contract will pay care staff a real living wage, and I know that Labour councils in Lambeth, Southwark and many other London boroughs have committed themselves to paying their care staff the London living wage.

[Karin Smyth (Bristol South) (Lab)]

As my hon. Friend is mentioning many councils, may I draw her attention to the work of Bristol City Council under Councillor Helen Holland? It is leading an important Proud to Care campaign to encourage more care workers back into sector, particularly at a time of increasing demand and labour shortages. Will she join me in commending Bristol City Council’s work in this area?

[Barbara Keeley]

I will indeed, because given the cuts that many councils have been facing—I am sure Bristol is the same—these efforts to protect care services are really excellent.

I was talking about those London boroughs that have committed to pay care staff the London living wage, which, at £10.20 an hour, is way above the Government’s so-called living wage of £7.83—a commitment that is no small undertaking. That is a further example of the good that Labour-run councils are doing for the most vulnerable people in their communities. We on this side of the House—this ties in very much with the point that my hon. Friend has just made—see the need for social care to be valued as a career. At last year’s general election, Labour pledged to implement the real living wage for all care staff and to ensure that care staff were paid for travel time, that 15-minute care visits were scrapped and that zero-hours contracts were ended for care staff. Those are important steps, but we know that we have to go much further if we are to improve care quality.

It is clear from the reports of the Care Quality Commission that staffing levels are still a major issue in those care services rated as inadequate or requiring improvement. Much of the care workforce are underpaid, undervalued and overworked, which leads to high turnover and vacancy rates in the sector among care staff and, more importantly, the registered managers who are responsible for overseeing care quality. Improving pay for care staff will help with that, but we also need to commit to improving care staffing levels to reduce the workload pressure and offer better training and career paths.

The National Audit Office has criticised the Government for failing to have an up-to-date workforce strategy for the care sector and for their lack of oversight of workforce planning in local areas. Indeed, the Government have no major workforce strategy for social care. It was the Labour Government who produced the last strategy, in 2009. The head of the National Audit Office has said:

“Social care cannot continue as a Cinderella service—without a valued and rewarded workforce, adult social care cannot fulfil its crucial role of supporting elderly and vulnerable people in society.”

Skills for Care has a budget of only £21 million for care staff training, whereas Health Education England has a budget of £4.7 billion. That disparity in budgets between health and social care says it all about the Government’s lack of priority for improving the quality of social care.

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. That aimed to relieve the pressure on the social care system. It would have been enough to begin paying care staff the real living wage and would have sought to offer more publicly funded care packages for people with different levels of need. Today’s debate is not primarily about the long-term funding of social care, but Labour has made it clear that maintaining the current funding system is not an option in the long term. Recently, polling by the Alzheimer’s Society has shown that paying for social care is a growing public concern and that there is overwhelming public support for a cap on care costs. The next Labour Government will implement a lower cap on care costs than the cap set under the Care Act 2014. We will also raise the asset threshold to a higher level than under the current system.

[Maria Caulfield (Lewes) (Con)]

I am listening with interest to the hon. Lady’s opening remarks. I am obviously interested in the cap, in paying care workers more and in raising the threshold, but how would a Labour Government pay for that?

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[Barbara Keeley]

I think there must be an echo, because the hon. Lady asked me exactly the same question in the last debate, six months ago. I said to her previously that there is a range of options that we could use to raise the money, including wealth taxes, an employer care contribution and a social care levy. However, it really is a bit rich of Government Members to raise that question when they have no idea whatsoever how they would take forward any social care developments. Furthermore, there was absolutely nothing in the Conservative party’s election campaign last year about the funding for anything. We had a costing document. We had a costed manifesto. I can stand here and say that we had the funding to put £8 billion extra into social care in this Parliament, including £1 billion this year. The Conservative party said nothing whatsoever about that.

[Sir Desmond Swayne (New Forest West) (Con)]

rose—

[Barbara Keeley]

I will not give way—I need to move on. When the Minister responds to the debate, she can tell us what the Conservative party is aiming to do, but I am afraid that there has been a complete cloud of obfuscation.

[Sir Desmond Swayne]

Will the hon. Lady give way?

[Barbara Keeley]

No, I need to move on. The Deputy Speaker has asked me not to take too long, and not take too many interventions. I have been very generous up to this point.

We believe that the time to act on this care crisis is now, but instead of taking the bold steps needed to fix the crisis, this Government are promising a Green Paper. Since the royal commission first reported on the long-term funding for the care of older people in 1999, we have seen 12 consultations and four independent reviews, so I really question why the Government are undertaking yet another consultation and producing yet another Green Paper. It is clear that they have become increasingly fond of consultations, reviews and Green Papers. In fact, they have launched more than 1,600 consultations since 2015, and more than 500 of them have not yet been completed. Sadly, I have to say that that includes the carers strategy. The Government spent £1 million on the Dilnot review, only to delay the introduction of its recommended care cap before shelving it indefinitely. The Government are wasting time and public money on consultations, and even more on adopting then shelving long-term funding solutions for social care.

The time to act is now. I urge the Government to give our social care system the funding it so badly needs, both this year and in the longer term, and I urge hon. Members to support our motion tonight. We must give councils the proper funding to deliver the high-quality care that people across this country need to live with dignity. That is nothing less than they deserve.

[The Minister for Care (Caroline Dinenage)]

I thank the hon. Member for Worsley and Eccles South (Barbara Keeley) for introducing the debate. We want this to be the best country in the world in which to grow old and in which people can face their third age knowing that they will be supported to live healthy, independent lives for longer and for as long as possible, with a choice of good-quality, affordable care that is there, should they need it. Today’s debate is a welcome opportunity to cover the action that this Government have taken to improve social care, highlighting a few examples where real progress has been made, as well as discussing our longer-term plans for the Green Paper, which will be published later this summer.

Most of all, however, I want to do something that the hon. Lady forgot to do, which is pay tribute to the extraordinary people—both the social care workforce and the informal carers—who play such a vital part in our health and social care system. At the heart of their endeavours is the commitment to do all they can to support individuals and families throughout the country.

[Barbara Keeley]

The Minister has just said that I did not pay tribute to informal carers. That is just not true. Everybody who knows me knows that I have never stopped paying tribute to informal carers, and I did so in my speech today. Please will the Minister not attribute comments to me that I did not make?

[Caroline Dinenage]

What I actually said was that the hon. Lady forgot to pay tribute to the social care workforce, who play such a vital part in our health and social care system. At the heart of their endeavours is the commitment to do all they can to support individuals and families throughout the country to live healthier lives with comfort, dignity and respect. However, it is absolutely right to begin by acknowledging that this sector has been through some really difficult times.

--- Later in debate ---

[Caroline Dinenage]

If the hon. Lady will bear with me, I will come on to discuss that, but there will be a separate, parallel workstream on working-age adults, who account for over half of the spending—

[Barbara Keeley]

Why?

[Caroline Dinenage]

If the hon. Lady will give me the courtesy of allowing me to finish my comments, I will explain why in a moment.

The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) wondered why we are going back to the past and looking at Labour’s record, but Labour is asking people up and down the country to vote for them in the local elections, so they will rightly look at Labour’s record and at how it dealt with the social care crisis when it was in government. After 13 years of inactivity and bluster, people need to be able to make a choice based on historically accurate facts.

[Barbara Keeley]

Will the Minister give way?

[Caroline Dinenage]

The hon. Lady had plenty of time to make her comments, so I will make a little progress.

When the Conservative party formed the coalition Government in 2010, it is worth remembering that not only did we have to deal with the parlous state of the country’s finances, but we inherited a burning platform of social care. Of course, that meant taking difficult decisions in those early years, which were challenging times for local authorities.

--- Later in debate ---

[Caroline Dinenage]

I will make a bit of progress.

The shadow Minister asked about Allied Healthcare. She is right to raise that, and I am grateful that she has done so. As she said, Allied Healthcare announced last Thursday that it is proposing a company voluntary arrangement to its creditors. I want to talk about that specifically because people across the country will be concerned. I spoke to the chief executive officer last Thursday to emphasise the importance of continuity of care for everyone receiving its services, both in adult social care and primary care, and the company has made it clear that those who receive services from Allied Healthcare will continue to receive the same level of care and that their care plans will not change.

[Barbara Keeley]

I am glad the Minister has responded in that way, but I asked her how she would ensure that 150 councils can fulfil their statutory duty to provide care if that company goes bust. We need to know a bit more than that she has had verbal reassurance. Of course the chief executive, in his current position, will try to give her verbal reassurance but, under the CVA, the creditors have to be satisfied within four weeks. What is going to happen if this company goes bust? Is it going to be another Southern Cross?

[Caroline Dinenage]

I am happy to answer the hon. Lady’s questions, which she is right to ask. Although we are very hopeful that this procedure will have a positive result, we are taking steps to ensure we are prepared for all eventualities. The Care Quality Commission and my Department are monitoring the situation, and the CQC will notify local authorities in the event it considers it likely that services will be disrupted as a result of business failure. The law means that local authorities will step in to meet individuals’ care and support needs if a care provider business fails and its services are disrupted. The relevant local authorities are working up contingency plans to ensure individuals’ care and support needs continue to be met.

While the long-term options are being resolved, it is right that funding for social care comes from a variety of sources, including business rates, general taxation and the social care precept. Delayed transfers of care is one area where that money is clearly making a difference. This Government are clear that no one should stay in a hospital bed for longer than is necessary; doing this removes people’s dignity, reduces their quality of life and leads to poorer health and care outcomes.

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[Caroline Dinenage]

I will certainly take that into consideration.

[Barbara Keeley]

The Minister is just proving that she was not listening to what I was saying. What I said was that the British Red Cross has said that it had found innumerable cases where discharges have happened so quickly that people were discharged without the right amount of care, and that can just lead to a cycle of readmission. A constituent told me that, in the case of Salford Royal, which is an excellent hospital, she felt she had been “thrown out of hospital.” That is what she told me.

[Caroline Dinenage]

I very much thank the hon. Lady for that clarification.

Our funding increases have gone into initiatives such as the better care fund, which provides a mechanism for local authorities and clinical commissioning groups to pool budgets for the purposes of integrated care.

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[Damian Green]

I will certainly give way to the right hon. Gentleman in a moment, because I am about to mention him, but I am conscious of time.

There needs to be radical change, and the Green Paper needs to be radical and brave, because although in this debate, as in the wider debate on this issue, a lot of people talk about the fact that we live in an ageing society, we have not remotely adjusted as a society to what that means yet. Our population is projected to grow by around 10 million over the next 40 years. Almost all that growth comes from older people, and particularly those in the oldest age group. There are 5.3 million people over 75 in Britain today. That number will double to more than 10 million in 40 years. This is not just a looming problem; it is a problem today. There is a short-term and a long-term problem to solve. Frankly, in the spirit of non-partisanship, no party has a record unblemished by using social care as a political football. Phrases such as “death tax” or “dementia tax” make good copy and can affect the outcome of elections, but they do not help rational debate or, more importantly, help us improve the lot of the increasing millions of older people.

[Barbara Keeley]

I wonder whether the right hon. Gentleman is admonishing his own Chancellor, who used the expression “death tax” in the last Budget.

[Damian Green]

I think that the phrase “death tax” dates back to the previous Labour Government’s attempt to solve the problem in 2008, and I am sure that the hon. Lady used the phrase “dementia tax” during the last general election campaign. I hope that she will reciprocate my attempt to be non-partisan—so far it does not feel like it.

In the short term, the challenge for the Government is one of capacity and quality of care. Both problems will become more difficult in the long term. There is a range of things that we must do as a society before people need social care. For example, we need to keep people active for longer, we need to keep them in the workforce for longer, because that is good for their health, and we need to make changes to the planning system so that we can keep them in appropriate housing of their own for longer. In the end, however, the nub of the issue will be funding.

I want to address a point raised by the hon. Member for Central Ayrshire about joining the whole thing up with health funding. I agree with the broad thrust of the 10 principles proposed by the right hon. Member for North Norfolk (Norman Lamb), the hon. Member for Leicester West (Liz Kendall) and my hon. Friend the Member for Grantham and Stamford (Nick Boles) yesterday, particularly the idea of hypothecation, whose time is coming, but I think there is a problem with the idea of simply integrating all health funding and all social care funding.

It is a no-brainer that, organisationally, social care and healthcare need to be much better integrated, so that the individual is not trying to negotiate a very complex system, as the hon. Member for Central Ayrshire said. If we simply roll all the funding together into one pot, however—a sort of national health and social care fund—there are two serious dangers. The first is that social care takes over from mental health as the Cinderella of the health system, never quite at the top of the priority list when money is allocated. The second is that nobody feels that their contribution is related to their personal needs. The effect is that some of the sources of funding that could be made available—I agree with all those who say we need more funding—such as the £1.7 trillion of equity in residential property, of which more than two thirds is held by the over-65s, would be in danger of being permanently excluded, which I think would be a great mistake.

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[Jackie Doyle-Price]

The ruling from HMRC is clear that those on sleep-in shifts are still entitled to the minimum wage, so we are working out a solution to those historical liabilities. We are clear that we expect all employers to abide by the national minimum wage legislation, and I hope that that gives the hon. Lady some clarity on that point.

We can expect the Green Paper to be brought forward, but I also want to address what Members have said about the variation in quality and availability of provision. As has been said, local councils are responsible for responding to that, and the CQC has rated 81% of care services as good, but it is important that we work with those that are performing less well to achieve significant improvements so that everyone is entitled to the best possible care.

I was pleased to hear the contribution of my right hon. Friend the Member for Ashford (Damian Green). His philosophical approach perhaps reflects the amount of time that he has spent thinking about this topic. I associate myself with the comment made by him and several Members across the House about the fact that no one has an unblemished record when it comes to debates about social care. If we are genuinely to come up with a long-term solution, we need a spirit of consensus to take people with us, and people on both sides of the House need to remember that.

In conclusion, we have had a full debate and it will not be the last time that we debate this subject. We are now quite a way down the track when it comes to working up real proposals to bring genuine reforms of the social care system to equip ourselves for a world where life expectancy ends not at 70, but at 100. That will require significant change. We are stepping up to the challenge and will bring forward proposals in due course.

Question put and agreed to.

Resolved,

That this House notes that Government cuts to council budgets have resulted in a social care funding crisis; further notes that Government failure to deal with this crisis has pushed the funding problem on to councils and council tax payers and has further increased the funding gap for social care; is concerned that there is an unacceptable variation in the quality and availability of social care across the country with worrying levels of unmet need for social care; and calls on the Government to meet the funding gap for social care this year and for the rest of this Parliament.

[Barbara Keeley]

On a point of order, Mr Speaker. The motion that has just been unanimously agreed calls on the Government

“to meet the funding gap for social care”—

widely said to be £1.3 billion—

“this year and for the rest of this Parliament.”

Given that Ministers have agreed to the motion, can you advise when we might expect an announcement from the Government on this important agreement on social care funding?

[Mr Speaker]

The most pertinent response that I can offer to the hon. Lady—I understand her perfectly legitimate point of order—is as follows. On 26 October 2017—obviously this was done in the light of a number of Opposition-day debates and motions voted thereon—the Leader of the House said in a written ministerial statement:

“Where a motion tabled by an opposition party has been approved by the House, the relevant Minister will respond to the resolution of the House by making a statement no more than 12 weeks after the debate.”—[Official Report, 26 October 2017; Vol. 630, col. 12WS.]

That is the position as things stand. The hon. Lady has registered her point with considerable force, it is on the record, and I do not dispute the fact of what she said about the motion being carried unanimously.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 20th March 2018 Commons Chamber

[Caroline Dinenage]

The Secretary of State has already had conversations with councillors about this matter, but my hon. Friend is absolutely right to raise it. The Care Act 2014 placed a duty on local authorities in England to promote diverse, sustainable, high-quality care, and it is important for them to continue to do that.

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

The National Audit Office says that our care system is not “sustainably funded”, the Care Quality Commission says that one quarter of care facilities are not safe enough, and care providers cherry-pick to whom they will give care places, and even evict people with advanced dementia on cost grounds. What is the Care Minister doing to address those issues and the sharp decline in public satisfaction with the social care system?

[Caroline Dinenage]

We know that the sector is under pressure because of the ageing population, but the Government have given councils access to £9.4 billion more dedicated funding over three years. The hon. Lady is right to emphasise the importance of putting power back in the hands of residents and their families, which is why we published a package of measures to ensure and protect consumer protections in the social care sector, and we will continue to look at that very closely.