National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2019

Baroness Jolly Excerpts

Monday 10th June 2019 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I share some of the concerns expressed by the noble Baroness, Lady Thornton—she has dug out a few that I have not mentioned or even thought of. Many of us here will have had friends or family in receipt of this funding. My mother received it towards the end of her life. By way of clarification, can the Minister confirm whether FNC is funded in the same way as end-of-life care? If so, is there the same sort of uplift?

It would be good to look at this in the context of a Green Paper. I know that that is a dig and something that we say frequently, but so much of this would be much easier to debate in your Lordships’ House if we had a Green Paper to read and could try to understand the Government’s intentions.

These changes will impact on CCG funding with effect from 26 April, so the increase is not within the CCGs’ budget for this year. What will the extra cost be to CCGs? Is there likely to be an in-year top-up to cover it, however small?

The patients we are talking about will be resident in nursing homes. I wonder whether the sector was consulted about the changes. What was its reaction to LaingBuisson’s estimate of a 3.1% efficiency uplift? What was LaingBuisson’s rationale? If the Minister has that in her notes, I would be interested to know where the 3.1% came from. Why was it not 3%? I am sure that a lot of people would like to know that—not least the sector.

[Lord Taylor of Goss Moor (LD)]

If my noble friend will allow me, I would like to ask a question. Is it not the case that the people who work in this sector are, by and large, extraordinarily low-paid while caring for some of the neediest people in this country? The collapse of so many providers in the sector suggests there is something fundamentally wrong, to which efficiency savings do not seem a realistic response.

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[Baroness Jolly]

My noble friend makes a very good point. The majority of people who work in the sector are care workers on the basic minimum wage, or something related to that. What we are discussing this evening is nursing care which will be paid at a union rate; nevertheless, it is stretching the sector.

The Minister knows about the shortage of nurses, and the noble Baroness, Lady Thornton, spoke about the shortage of care workers. Why do we have restrictions on agency nurses’ nursing hours of 10% of the total? Clearly, we cannot have agency nurses covering the whole thing; everyone across both health and social care frets about agency nursing and its expense over and above that of paying for directly employed people. But what is a nursing home to do if there are no salaried nurses available? Is the 10% smoothed over a month or a year? Is this realistic? How realistic is it for less than 10% of nursing hours to be delivered by the agency? This will be locally variable—relatively straightforward, perhaps, in city settings but where my noble friend and I live in Cornwall, people such as agency nurses are like hens’ teeth. This is not straightforward, and I am not convinced that it is absolutely workable.

This measure looks hurried, but I suppose any increase is welcome. I await the Minister’s response to some of the comments that I have made and those of the noble Baroness, Lady Thornton.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I open with an apology for the state of my voice. I shall do my utmost to make myself heard and make it to the end of my speech. If I do not manage to answer all the points made, I shall write not only to the two noble Baronesses who have raised questions but to all those present in the debate, and will place a copy of that letter in the Library.

I would also like to identify myself with the points raised by the noble Baroness, Lady Thornton, regarding Carers Week, and to pay tribute to all those carers in this country who make tremendous sacrifices for those they care for. We should all thank them for the work they do. Our system would not cope without them; we should all be very grateful.

I turn to the questions that have been raised. NHS funded nursing care is of course an incredibly important part of the health and care system, supporting the provision of nursing care in nursing homes. The NHS funded nursing care rate plays the important role of ensuring that neither individuals nor local authorities have to pay for nursing care, which is the responsibility of the NHS. My department is seeking to ensure that nursing home providers are paid a fair rate for employing registered nurses, so that nursing care can be provided to all who need it. On the point that was just raised, it is helpful to know that the average pay for registered nurses in the independent sector has now risen from £23,400 to £29,400, so that is the benchmark we are talking about.

The noble Baroness, Lady Thornton, raised the issue of the nursing care rate for 2019-20, which my department set in regulations in April. This was done, as she said, following the LaingBuisson report into the costs of providing NHS funded nursing care to nursing home providers, after further consideration by my department. Following this work, the rate has increased by 4.7%, which is a significant increase above inflation, as has been recognised. The efficiency expectation, which is regretted in tonight’s Motion, should be seen in the context not only of this above-inflation increase but in the context of the significant increase of 40% which came in 2016-17; that is part of the picture that the efficiency expectation was put in place to address.

It is only right at a time of continued and much-needed investment into nursing home providers—ensuring they are able to employ and retain registered nurses—that the Government and the NHS also expect those providers to deliver as efficient a service as possible and value for money to the taxpayer. The 4.7% increase in the nursing care rate for 2019-20 is a far larger increase than that being seen in the vast majority of prices across the wider public sector and NHS; this is because of the priority that we have set on that rate. For example, the NHS national tariff is increasing the majority of prices in the NHS by 2.7% for 2019-20. The national tariff has also asked most NHS providers to make efficiencies of 3.1% across 2018-19 and 2019-20, and the Government believe that while still getting an above-inflation increase, nursing home providers should be able to do the same.

The LaingBuisson report provided evidence showing that many nursing home providers are already delivering nursing care more efficiently than others, so there is variability in the system. The study shows wide variation in the cost of delivering nursing care, even when factors such as region or provider size are taken into account. Efficient providers surveyed were shown to deliver an hour of NHS funded nursing care for 18% less than others. Additionally, the study showed that nursing home providers are increasing their use of agency nurses, as has been discussed. An hour of agency nursing costs 47% more to providers, and so, obviously, to the NHS. We believe that providers can work to reduce the proportion of their workload covered by agency nurses, as we have required other parts of the NHS to do, in a sustainable way.

There is a need to ensure value for money in important NHS services and to maintain their sustainability. The Government believe that efficiencies can be made in relation to the rate this year—for example, in the use of agency nurses. However, this is still within the context of a significant and above-inflation increase to the nursing care rate. That is why we think that the rate set is achievable.

The noble Baroness, Lady Thornton, also raised the important issue of the need for a long-term funding settlement for social care and financial sustainability for the sector, as she has on more than one occasion in this Chamber. The Government have already given councils access to around £10 billion of additional dedicated funding for social care over this spending review period. This includes a £240 million adult social care winter fund for 2018-19, and again for 2019-20, to help local authorities. It is the biggest injection of funding for winter pressures that councils have ever received. As a result of the measures the Government have taken, funding available for adult social care is increasing by 8% in real terms from 2015-16 to 2019-20. Councils have responded by increasing their spending on social care, so the money has gone where it was supposed to, which is always encouraging.

Local authorities were also able to increase the average fees paid for older people’s residential and nursing care by 6.4% in 2017-18, which we believe brought more stability to the market. When we look into the detail of the figures we see that, while there has been a reduction in the number of care homes, the overall number of social care beds has remained broadly constant over the last nine years, with an increase in nursing beds and care home agencies. As in any market, there will be inevitable entries and exits of care organisations, but we feel that there is some consistency. It is more reassuring than it may appear on the surface.

As we have also discussed, social care funding for future years will be settled in the spending review, where the overall approach to funding of local government will be considered in the round. We are also looking ahead to ensure that the social care system is sustainable in the longer term so that we can continue to deliver as our society ages. This is why the Government have committed to publishing a Green Paper at the earliest opportunity, setting out proposals for reform.

I hope I have answered the majority of the questions raised by the noble Baronesses. If I have failed to respond to anything, I hope they will allow me to write.