Local Government and Social Care Funding
Baroness Keeley Excerpts(5 years, 7 months ago)
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Madam Deputy Speaker (Dame Rosie Winterton)
Order. Before I call the Scottish National party Front-Bench spokesperson, I advise colleagues that about 25 Members want to speak. If everybody sticks to around 10 minutes, we will not need to impose a time limit.
Barbara Keeley (Worsley and Eccles South) (Lab)
On a point of order, Madam Deputy Speaker. I did not get the chance to correct the Secretary of State, so it is important that I do so now. My hon. Friend the Member for Chesterfield (Toby Perkins) quite rightly mentioned the instability of the care market, but the Secretary of State provided an incorrect impression of the situation. Research by Care England shows that there are now 564 fewer care homes when compared with 2015 and that there has been a net loss of 8,119 care home beds nationwide. The Secretary of State gave an incorrect impression, and we should not carry on the debate after that sort of wrong impression has been given.
Rachel Maclean (Redditch) (Con)
It is a great pleasure to follow the hon. Member for St Helens South and Whiston (Ms Rimmer). She gave a very good and comprehensive speech, but I cannot say the same about the hon. Member for Denton and Reddish (Andrew Gwynne), the Opposition Front-Bench spokesman, who gave an impassioned speech that was no doubt great for Facebook clicks but bore very little resemblance to the reality and substance of the debate today. We have a true cross-party challenge that we need to address, and he conveniently chose to ignore some of the critical points about council funding, as it is distributed across our country.
Many Opposition Members spoke about Birmingham, a city that I know well. It is a great city; I have lived and worked there for many years. They were decrying the Government for their seeming neglect of spending in Birmingham. The blame for the problems in Birmingham lie firmly at the Labour administration’s door. Shall we just look at the facts? In my constituency in Worcestershire, the core spending power per dwelling is £1,356, and in Birmingham, it is £2,022—nearly 50% more. Yes, this reflects the need, but we have need in my area of Redditch as well. What is that administration doing with the money? It is squandering the money on consultants and inefficient services, when it cannot even collect the rubbish on the streets. There is rubbish piling up. It is breaking its promises to the electorate. It cannot collect the bins. The strikes have cost it £12 million, which could have funded the council tax rise that it has just inflicted on its residents.
However, that is enough about Birmingham and enough about that. I want to focus on this very important issue, on which I think there is more consensus than there is political point scoring. There is no doubt that adult social care is an absolutely critical issue. As a Member of Parliament, I hear from people who have tragic stories and face very difficult choices. I am also the daughter of a dementia sufferer, who lives on her own in Cumbria. I have seen at first hand the difficulties and challenges of navigating the system to support a frail, vulnerable lady in a very isolated rural area. We all have constituents that suffer from dementia and other conditions, so we need to grapple with this issue.
It is right to say that the lack of a social care Green Paper is a missed opportunity. I am delighted to be the co-chair of the all-party group on carers, which is doing some excellent work. Carers, of course, are the unsung heroes. They provide £132 billion-worth of care across the UK. Over the next 10 years, 20 million people will start caring. We know that unpaid carers make a huge contribution in so many ways, so I gently call on the Minister to address that.
Barbara Keeley (Worsley and Eccles South) (Lab)
The hon. Lady is rightly raising the plight of carers, which is a subject that is very close to my heart, as it seems to be to hers. Does she also regret the lack of a national carers strategy from her Government? The last national carers strategy was produced in 2009 and there is a campaign among carers to get the Government to produce one. We do not have a Green Paper and we do not have a national carers strategy.
Rachel Maclean
I thank the hon. Lady for that point; we work together on the all-party group and we share those concerns. I was about to press the Minister for more updates on when we can see the Green Paper, because while this debate is about local authority funding, of course there is also the role of carers and joining up the role of carers in the national health service and in local authorities. Those services have to work together and that is a critical part of this debate.
Norman Lamb
The hon. Gentleman is absolutely right to highlight the issue of how we care for people of a younger age who have care needs, particularly those with learning disabilities and autism. What happens too often is that those people end up in institutions when they do not need to be there, often away from home and at enormous cost to the public purse. Again, the evidence from around the country shows that where this is done well and where families are supported to keep someone at home, helping them through crises, we not only reduce the cost to the public purse but have a massive impact on their wellbeing. He is also right to highlight the fact that we end up with awful disputes about who is responsible for payment as people are shunted around the country in a way that, in my view, fundamentally breaches their human rights.
Barbara Keeley
I am glad that the right hon. Gentleman is talking about this topic. It is absolutely vital, but does he regret the extent to which the Government now seem to have abandoned the transforming care programme? There seems to be no future for it. From the time when he was a Minister, there was a programme to deal with the issue that my hon. Friend the Member for Stroud (Dr Drew) raised, but there now appears to be an abandonment of targets and an abandonment of the future of that programme, and certainly no funding to make it work.
Norman Lamb
I am deeply concerned about the future—or lack of a future—of the transforming care programme. One of the problems is that it is often NHS England that is funding care in an institution, and when a local authority is under financial stress, there is not much of an incentive to take that person out of the institution and make them the responsibility of the local authority. There has to be a way of funding the building of infrastructure to support people in the community. That is what has failed to happen so far.
This is not a static issue that we face. There is growing pressure. We are all living longer, often with chronic conditions that in the past used to kill us. That is a great triumph of man and womankind, but there is a cost attached, yet we have no mechanism to address the increasing funding needs of social care and, in particular, dementia.
The hon. Member for Chelmsford (Vicky Ford), one of the valued members of the Science and Technology Committee, made the point that the cost to society of dementia is about £26 billion every year, but that is going to rise dramatically. Whatever we say about spending money efficiently—I completely agree about the need to spend money efficiently and to innovate and do things in a more effective way—the dramatic rise in demand inevitably means that we will have to spend more as a society on supporting people with dementia and on research to find cures for dementia.
Barbara Keeley (Worsley and Eccles South) (Lab)
Today, we have heard from many hon. Members about the disastrous impact of the Government’s relentless and short-sighted cuts to council budgets from Hull to Westminster North, from York to Nottinghamshire, from West Ham to Lewisham, from Birmingham to St Helens, from Sheffield to Exeter, Burnley, Hartlepool, Tyneside, Chesterfield and many others. Nowhere, as we have heard in the debate, has that disastrous impact been felt more acutely than in social care. I congratulate my hon. Friends the Members for Kingston upon Hull West and Hessle (Emma Hardy) and for Crewe and Nantwich (Laura Smith), whom we heard from in the past hour, on presenting such powerful stories about family carers and the role of care staff, the absolutely vital two parts of the backbone of social care.
Social care is one of the most important pillars of support for vulnerable people up and down the country. I pay tribute to all our dedicated and hard-working care staff, many of whom are in the dilemma my hon. Friend the Member for York Central (Rachael Maskell) just talked about. It is sad that the cuts mean we are in a situation where care staff have to go on strike for their pay, because many of them go above and beyond in the most difficult of circumstances to make sure that older people and disabled people get the help they need. We think a lot about NHS staff, but let us face it: without our 1.4 million care staff the care system would simply collapse. My hon. Friend the Member for St Helens South and Whiston (Ms Rimmer) raised the crucial fact that there are 110,000 vacant posts in the care workforce. That vacancy rate is deeply concerning, because it makes the situation for the staff who are doing the job much, much worse.
The Government should be shouting from the rafters about the value of social care, but most of the time there has instead been a wall of silence. It is only by securing this Opposition day debate today that we have been able to raise this issue. There is very little coverage of the issue elsewhere. My hon. Friend the Member for Redcar (Anna Turley) talked about the vacuum around Government policy on social care, and she was right to do that. Ministers seem not to want talk about a vision for social care. That is not surprising, I guess, following the Government’s litany of broken promises about reform. Let me just touch on some of them.
The Government dropped the cap on care costs, due to come into effect in 2016—we had legislated for a cap on care costs—leaving thousands of people unexpectedly having to pay for their own care. Then, at the general election in 2017 we had the so-called dementia tax, a disastrous proposal which lasted only four days before being abandoned. I have met family carers who are still desperately worried about that policy, because they think it is still around. Now, more than two years after promising a social care Green Paper, with the hope of better support for families across the country, the Government are still no nearer fixing the crisis that they have made. Let there be no doubt about it: this crisis has been made so much worse since 2010. We were told there would be a Green Paper in summer 2017 and then by the end of 2017, but it never arrived. It was then delayed till summer 2018 and then autumn 2018. Winter came and still no Green Paper. The Secretary of State told us at the start of the year that it would arrive by 1 April. It has not arrived and there is still no sign of the Green Paper. Perhaps the Minister will tell us when we are going to see it.
Now, when councils need an extra £1.5 billion to close the funding gap, the Government have offered derisory short-term funding. Last winter, the Government offered a measly £240 million for adult social for winter pressures. That would pay for only three months of home care for the older people the Secretary of State said it would help, but that is not enough. That was hardly enough for the harsh conditions of last winter, which, if you remember Mr Speaker, lasted very much more than three months. This year, councils will receive a further £410 million to be shared between older adults, working-age adults, and children’s social care services. The Secretary of State is leaving councils and councillors to make the invidious choice between caring for the most at-risk children, vulnerable adults with disabilities, and our most frail and isolated older people. Throwing small, one-off pots of money at this problem every year will not deal with the crisis in the long term. As my hon. Friend the Member for St Helens South and Whiston said, it is a sticking plaster on a gaping wound.
James Cartlidge
Will the hon. Lady set out her preference for how we should pay for long-term care?
Barbara Keeley
We get this every time we have a debate on social care—although we do not have many such debates—from Government Members who have no ideas whatsoever. I have just run through all the abandoned ideas and the abandoned promises that the Government have made on the Green Paper. I am really surprised that any Government Member actually has the cheek to stand up and ask Opposition Front Benchers what we would do. We laid out what we would do in 2010. We had a White Paper, not a Green Paper. We laid out all our proposals in our manifesto. We are the side with ideas and proposals on taking forward social care. This Government have no ideas and no vision, and I am amazed that an hon. Member really has the cheek to do that.
James Cartlidge
It is very kind of the hon. Lady to give way. I spoke in the debate and said that we have some very difficult decisions to face. We need to be open with the public, and I said that we need to look at, for example, equity in residential property. I think that is unavoidable. Does she think we should do that?
Barbara Keeley
We have laid out our proposals and we said how we would fund them. As I say, most of what we are debating today relates to the short-term crisis. Once we got past the short-term crisis, I think the hon. Gentleman would have difficulty. There has been talk about involving the public in this. At the moment, the public are faced with the type of care that my hon. Friends have discussed and debated and with the care staff and workforce in the situation that they are in. At no point, in the middle of a crisis, would we be saying to the public, “Use the value of your property. Let’s go for this type of funding or that type of funding.” That is cloud cuckoo land. I wonder whether the hon. Gentleman listened to my hon. Friend the Member for Kingston upon Hull West and Hessle talking about that absolutely crucial example. What would he say to those people who need care? That is the question for him to answer.
Councils need sustained investment that undoes the damage of years of austerity and cuts, but the Government’s choice—[Interruption.] The hon. Gentleman is sitting there smirking at me at the moment. The Government have made a choice to pursue ideological cuts to council budgets that have seen £7 billion lost from adult social care spending since 2010. Let us think about what that has meant: 400,000 fewer people getting publicly funded social care between 2010 and 2015; 100,000 fewer people getting taxpayer-funded social care in the last four years alone; and 90 people a day dying before they receive the public social care for which they have applied.
It is not simply the most disadvantaged who are losing out either. Many of those who are having to foot the bill for their care are being exploited by a broken care system where private care providers can act with impunity and where vindictive care homes can evict older people whose families dare to complain about their standard of care. That is a very serious matter, as we discussed in the debate, given the level of closures of care homes and the loss of care home beds we have had, as touched on by my hon. Friend the Member for Chesterfield (Toby Perkins). The hon. Member for Totnes (Dr Wollaston) also talked about being in a part of the country where it is impossible to get care. That is the position we are in. If care home owners can evict older people, that is a drastic situation. Opportunistic home care agencies are overcharging vulnerable people for care visits that are too short and endangering their health by forcing staff to work when they are sick. We heard about the care staff who are too scared to take time off sick.
I want to make clear to hon. Members the human impact of not getting the right amount of support, although those who have bothered to attend this debate—I am thinking particularly of Government Members—might have heard some examples. Simply put, it means people going without the support that they need to live with basic dignity. Not having needs met means going unwashed and undressed. It can mean waiting for hours to go to the toilet because no help is available. It can mean a person going thirsty because there is no one to pour them a glass of water and going hungry because there is no one to prepare them a proper meal. This is the experience of many thousands of older people who are going without care or who have insufficient care. I am glad that many hon. Members have talked about a care visit being the only contact that many older or vulnerable people have in the day.
The consequences of inadequate support in the community for working-age people are also horrifying. In recent months, we have seen many reports of vulnerable autistic people and people with learning disabilities left to languish for years in private in-patient units—vulnerable, detained, secluded and neglected in long-stay units. These units, many of them private, are funded by the NHS at great cost to the taxpayer because councils simply have not been given the money to move people from these units to be supported closer to home. My hon. Friend the Member for Stroud (Dr Drew) and the right hon. Member for North Norfolk (Norman Lamb) both raised that issue. I have stood at this Dispatch Box before and called this a national scandal, and I make no apology for doing so again.
Back to Government promises: after Winterbourne View in 2011, the Government promised to close inappropriate units for good within three years—by 2014. It did not happen. Indeed, eight years later, there are still 2,260 people detained in hospital settings when they need not be there. The number of adults trapped in these units has fallen by only a fraction. Worse still, the number of children in these units has actually increased.
Where this Conservative Government have done nothing, Labour will act: rather than years’ more cuts, we will invest £8 billion in social care; rather than 90 people a day dying waiting for care, we will provide more people with the support they need; rather than care staff being pushed to the brink, we will pay them a real living wage; and rather than more delay, we will build a national care service that supports older and disabled people when they need it. This is our message to people across the country, young and old, desperate for care and support: a Labour Government will give you the support you need and deserve. That is why I urge Members to support our motion tonight.
Caroline Dinenage
As the hon. Lady will know, a version of the Green Paper already exists, but that does not mean that we are resting on our laurels while we are waiting for an opportunity to publish it. We are continuing to improve it and evolve it so that when we do publish it—as soon as possible—it will be in the best possible shape.
My hon. Friend the Member for Chelmsford also spoke about dementia, and about the importance of investing in dementia care and research. We lead the world in this regard, but we know that there is more to be done if we are to achieve our aspiration of being the best place in the world in which to live with dementia by 2020.
The hon. Member for North Tyneside (Mary Glindon) spoke about some of the difficulties for councils that had been addressed by “working smarter”. She also said that she thought it unfortunate that councils had had to raise council tax in order to have the money that they need. I point out to her gently that the average annual increase in council tax bills from 1997 to 2010 was 5.8% and since 2010 it has been only 2.2%—half what it was under the previous Labour Government.
The hon. Member for Lewisham, Deptford (Vicky Foxcroft) spoke about youth violence and the importance of schools, social services, voluntary sector organisations and public health bodies working together through a community-led approach to deal with it. She was absolutely right.
My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) spoke about the challenges facing rural communities and the higher costs of delivering things such as domiciliary care. She also spoke about the importance of innovation, quality of care and being outcome-focused. She spoke glowingly about the National Centre for Rural Health and Care.
I always listen very carefully to what the right hon. Member for North Norfolk (Norman Lamb) has to say because he has done this job. He spoke about the importance of investing in prevention and said that social care must help people stay independent for longer. He admitted that this job is not quite as easy as it looks and that when he was fulfilling it, there were difficult funding decisions that had to be made. It will be no surprise to him that that continues to be the case and that nothing has changed since he left the role. It is important that he recognises that the challenges continue.
The hon. Member for Chesterfield (Toby Perkins) said that innovative choices have had to be made, that there are better services that cost less in his constituency and that the local authority has had to invest in order to save money. He did make a couple of errors, unfortunately. He mentioned that Labour councils are producing lower council tax, but everybody knows that it is actually Conservative councils that deliver better value for money, with a combination of delivering great quality services while keeping council tax lower than either Labour or the Liberal Democrats.
The hon. Members for Burnley (Julie Cooper), for Bradford West (Naz Shah), for Warrington South (Faisal Rashid), for York Central (Rachael Maskell) and for Peterborough (Fiona Onasanya) all made passionate speeches, mainly about the impact of austerity on areas of deprivation.
The hon. Member for Redcar (Anna Turley) spoke about an innovative employment hub that has grown from the loss of the steelworks in her constituency. She spoke about the Care Academy in Cleveland, which is doing great work equipping more people for roles in adult social care. She mentioned how the challenges of caring for an ageing population are being addressed at a local level. I say to her that that is something that will have to be addressed not just at a Government level, but at a local level and a voluntary level. We all have to work together to face these challenges, which are being faced the world over.
The hon. Member for Totnes (Dr Wollaston) spoke about how important it is to have cross-party and collaborative work on this issue. We all face difficult choices. For too long, adult social care has been used as a political football. Even today, the Opposition spokeswoman talked about the dementia tax once again. That is very unhelpful language that does not help us come to a meaningful consensus or to work together.
Caroline Dinenage
I will in a moment.
The hon. Member for Crewe and Nantwich (Laura Smith) asked about the important issue of sleep-in shifts. The Court of Appeal judgment last summer ruled that employers are not required to pay the national minimum wage. That has now gone to the Supreme Court, the ruling of which should give clarity to both providers and employees. The Government have taken account of the costs deriving from the national minimum wage and gave an additional £2 billion of funding to local authorities in the spring Budget of 2017. We encourage employers to pay more than the minimum wage where possible, and I recently wrote to local authorities to state my view that the judgment should not be used as an opportunity to make ad hoc changes.
Caroline Dinenage
I am just going to make a bit of progress.
The hon. Member for Glasgow North East (Mr Sweeney) highlighted the difficult choices we have had to make. By painting an even bleaker picture of how things have panned out north of the border, he showed just how difficult those choices have been.
The hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) spoke movingly about her constituents, Paul and Lily. She was right to highlight the very personal cases and individual stories that every single one of us comes across in our constituency casework. If she wants to send me more details, I am happy to raise the issue with my colleagues at the Department for Work and Pensions.
The population is ageing. The number of people aged 75 and over is set to double over the next 30 years, and the number of people of working age with care needs is also growing. Some of today’s speakers have painted a picture of a social care system that is broken as a result of a lack of funding, but the truth is that while money is undoubtedly tight, if we are to face the challenges of an ageing population, we need to do more than just put more money in. We need a large-scale reform of the system if we are going to face the future with confidence that we can care for and support those who most need it. In the short term, we have put in around £10 billion of additional funding, but we will be bringing forward an adult social care Green Paper that will look at the long-term funding of adult social care.
Question put and agreed to.
Resolved,
That this House notes that despite the Prime Minister announcing that austerity is over, local authorities’ spending power per household is on course to fall by an average of 23 per cent by 2020, and that nine of the 10 most deprived council areas in this country have seen reductions that are almost three times the average of any other council under this Government; recognises that this has resulted in social care budgets in England losing £7 billion; further notes that at the last General Election Labour committed to a fully costed plan to invest an additional £8 billion in social care over this Parliament; and calls on the Government to ensure that local authorities and social care are properly and sustainably funded.