Social Care: Funding

Baroness Brinton Excerpts

Thursday 5th July 2018 Lords Chamber

Asked by

[Baroness Brinton]

To ask Her Majesty’s Government what steps they are taking to ensure that social care in England is adequately funded.

[Baroness Brinton (LD)]

My Lords, today, the country marks the 70th anniversary of the NHS, but another equally important anniversary next month is not getting the publicity it deserves. The Seebohm report, which laid the foundations for adult social care, was published 50 years ago in August. It was an important next step that set out the way for society to provide the right support for those in our communities who needed care, whether at home, in sheltered accommodation or in a residential or nursing home. I can remember, as a schoolgirl in the late 1960s, visiting a lady in my home town’s elderly care home. It was the old workhouse, with long wards and little communal space. It was a grim and desolate place to live. Most of the residents had no visitors. How different many of today’s services are, where the focus is on keeping our elderly active and independent for as long as possible, with rooms of their own for privacy. We know that good adult social care is an absolutely vital service that transforms people’s quality of life and that it is inextricably linked with the NHS. The sustainability of the NHS cannot work without a sustainable social care system.

Much has happened in the intervening 50 years since the Seebohm report but, shockingly, over the last few years much has also gone backwards. Many of us were encouraged when the 2011 independent Dilnot Commission on Funding of Care and Support proposed a carefully structured new integrated system with a cap on social care costs, which could enable people to plan for their old age. However, since 2015, the Conservative-majority Government—and now Conservative-minority Government—have dithered and delayed, repeatedly promising that they would sort out the social care funding problem. We still await the Green Paper promised in the Conservative manifesto last year, and have seen the side skirmish of the dementia tax, a form of inverse Dilnot which so outraged voters it was dropped by the Prime Minister mid-general election.

The aspirations for a sustainable social care system, fully integrated with the NHS, are, I think, all agreed in principle. However, the current funding mechanisms make it impossible to deliver. Local authorities have faced massive cuts to all services, making £6 billion of savings in adult social care since 2010. They are still being asked to make more each year at the same time as coping with increased numbers of elderly living in their communities and an increasing number of disabled adults and children. Worse, public health, one of Seebohm’s key pillars, has taken a double hit, with £200 million cut in 2015 and a further reduction of over £300 million proposed.

These numbers are shocking enough, but the reality of reductions in funding is a reduction in services for vulnerable adults, increased charges to clients and distressing waits for people to be discharged from hospital to receive care in their communities. It is also affecting our NHS, minute by minute, hour by hour, day by day. The A&E crisis, with ambulances queuing for hours, typifies how failing to tackle social care funding impacts on the NHS. I applaud the recent announcement by the Government to rename the Department of Health as the Department of Health and Social Care, but the renaming will do nothing without the funding. The King’s Fund has identified a local government funding gap of over £2.5 billion by 2020, which is close to the Local Government Association’s own estimates. The NAO said, as it published its recent report on the health and social care interface:

“The report finds that the financial pressure that the NHS and local government are under makes closer working between them difficult and can divert them from focusing on efforts to transform services. Short-term funding arrangements and uncertainty about future funding make it more difficult for health and social care organisations to plan effectively. Although the report acknowledges the recent announcement of extra funding for the NHS, additional funding has, at times, been used to address financial pressures, rather than to make essential changes to services or adopt new technologies”.


It is those efforts to transform services that are most affected.

That is why it is good to hear that a number of think tanks and other organisations are researching this. For example, Independent Age has commissioned a series of ground-breaking data to identify the costs of social care. The project will look at the social care funding gap going up to 2031 and hopes to offer financial options that can help provide the resources needed for free personal care, as well as reporting on how these funding options will affect different social groups across the regions. The data from these reports will highlight how much the social care gap will increase without intervention, but will also offer solutions on how the Government can fill the void by modelling various revenue-raising streams, such as changes to income tax, national insurance, an age-related levy, council tax, business rates and corporation tax. It hopes also to calculate the income distribution across local authorities for each funding option.

I have one main question for the Minister. The long-promised government Green Paper must have exactly this sort of data and research sitting alongside it, along with a promise of how services will be funded. This must happen as soon as possible—there can be no more delays. Can the Minister guarantee that there will be no further delays in bringing forward a proposal to provide a real, fully funded way forward? This is necessary because behaviour in both the NHS and the social care system is being driven by financial constraints, not by the needs of individuals.

One of the more shameful periods of our history has been the warehousing of children and adults with learning and physical disabilities, who were removed from their families and even their communities. That was the norm 50 years ago, and 30 years ago there was a recognition that this was—to use a parliamentary word—inappropriate. It was more than that: it was just wrong. Over the last quarter of a century, we have moved to a better—but not perfect—system of providing where possible tailor-made support to individuals. Surely that is what a society should do for its most vulnerable members. But cuts are now driving a different behaviour.

The disability champion Lucy Watts, who was awarded an MBE for her services to young people with disabilities, lives at home with her family, who help to provide her social care support, alongside a complex care package to meet her needs. In March, when her mother was taken into hospital with a brain tumour, Lucy was told by Castle Point and Rochford Clinical Commissioning Group that she would have to move into an elderly nursing home or a learning disability home instead of staying in her own home. She is neither elderly, nor does she have a learning disability. Worse, she was told that she would not be allowed to go out, not even to visit her mum in hospital, because as a resident she would have no right to be independent. There is a happy ending to Lucy’s story: the CCG backed down. I have to say that taking on one of the country’s best young advocates for disability did not work well for it, but there are increasing reports of new care packages not offering supported living at home but a cheaper, institution-based package that removes independence but may save the funders money.

Other behaviour is worrying too. Your Lordships may know that I work closely with the Disabled Children’s Partnership, and especially with parents of the most severely disabled children in Hertfordshire, who have been fighting to keep their short-break centre open. Nascot Lawn, funded by the CCG, is special because it offers proper medical support, which these children need. The Disabled Children’s Partnership report that short-break support and social care support, whether provided by the NHS or by local authorities, is being limited and cut across the country. In the case of one family, this has meant they cannot manage their child 24 hours a day, seven days a week, 52 weeks a year, and their child has now been moved to a long-term hospital. Instead of costing the state a few thousand pounds per annum, the cost is now closer to £250,000. Some CCGs now have funding people sitting on assessment panels. That is wrong. The law is clear: an education and healthcare plan for someone aged under 18 must address the needs of the child.

The better care fund, created by the coalition as a pilot for the sharing of good practice and for helping more funds to go into local authorities to ensure that people are moved out of the NHS and back into their communities with social care support, is important and remains an excellent interim plan. Since 2015, the Government have increased the funding going into it, but they have repeatedly delayed the new funding mechanism for social care. Specifically, the delays to the Green Paper, at the same time as announcements about the long-term funding of the NHS, demonstrate that there is a failure to grapple with the social care system in England and its systemic fault lines with the NHS.

Integration is essential, with new partnerships across England—real partnerships, with joint funding and shared KPIs. A long-term funding settlement, owned by government, Parliament, all political parties and the people, is essential if we are to have a social care system of which we can be proud.