Social Care: Funding

Baroness Manzoor Excerpts

Thursday 5th July 2018 Lords Chamber

[Baroness Manzoor (Con)]

My Lords, I thank the noble Baroness, Lady Brinton, for bringing this important debate on social care funding to the House. I thank all noble Lords for their valuable contributions. I want to take this opportunity also to personally wish the NHS and our social care system a happy 70th birthday. I thank all the people who work in it for their commitment and dedication in often difficult and challenging circumstances.

Everyone is entitled to good-quality care and support; as the noble Baroness, Lady Brinton, and the noble Lord, Lord Beecham, said, they are vital. We recognise that, as the noble Lord and others said, there are challenges, and we are doing something about them. Although 81% of adult social care providers are rated “good” or “outstanding” by the CQC, as of March 2018, it is completely unacceptable that standards in some settings fall below those rightly expected by care users and their families. That is why the Government have introduced tougher inspections, led by the Care Quality Commission, to make sure that services meet quality and safety standards.

The noble Lords, Lord Parekh and Lord Beecham, the noble Baroness, Lady Jolly, and my noble friend Lady Eaton stated that social care spending has stopped or has gaps in funding, but over the years, more money has been spent on social care. However, the growing population and the fact that people—including people with disabilities—are living longer are contributing factors, as acknowledged by my noble friend Lady Eaton. The noble Baroness, Lady Brinton, acknowledged that in the short term, the Government have given councils access to up to £9.4 billion more in dedicated funding for social care over the three years up to 2019-20. This means that overall funding for social care is increasing by 8% in real terms over this spending review period.

The additional resources are helping councils to commission care services that are sustainable and diverse, offering sufficient high-quality care and support for people in their areas. As I have already said, I recognise that there is much more to do, as stated by the noble Lord, Lord Beecham, the noble Baroness, Lady Brinton, and my noble friend Lady Eaton. Performance is not just about money. Funding will be supplemented with targeted measures to ensure that the areas facing the greatest challenges improve services at the interface between social care and the NHS.

My noble friend—he is a noble friend—Lord Beecham mentioned Newcastle. Thanks to a range of government actions, Newcastle-upon-Tyne received an additional £20.4 million for adult social care in 2018-19. We have already seen a real difference to services across the country. Social care-related delayed transfers of care had been rising year on year between 2014 and February 2017, but since taking action last year, we have achieved a reduction of 40%. Some councils, such as Darlington, Slough and Telford, had no delayed discharges, which I know my noble friend Lady Eaton will be pleased to hear.

Looking ahead, it is right that social care funding be agreed alongside along the rest of the local government settlement at the forthcoming spending review. Decisions on future reforms must be aligned, which is why we will publish the Green Paper in the autumn, around the same time as the NHS plan. As identified by the noble Baroness, Lady Brinton, yesterday’s NAO report also made it clear that,

“the changing needs of the population require changes to the way health and social care services are organised and delivered”.

I cannot give the guarantee that the noble Baroness requested regarding the timing of the Green Paper, but I will return to some of the issues that she raised. The NAO also stated that carers and those who need care must be put at the centre of any reform. The Green Paper will take its report into account.

The noble Baroness, Lady Jolly, and the noble Lord, Lord Beecham, raised the issue of the Competition and Markets Authority report, which also presented important findings on the care market, the need to strengthen consumer protections and the importance of supporting people to make choices about their care. Having accepted all of the CMA’s recommendations earlier this year, we are now working closely with industry, wider stakeholders and the CMA through the implementation phase. Those issues will be further addressed in the Green Paper.

As stated by a number of noble Lords, through the better care fund, local areas voluntarily pooled more than the minimum required in both 2015-16 and 2016-17, taking the total to £5.3 billion and £5.9 billion respectively. In 2015-16, 90% of local area leaders said the better care fund had already had a positive impact on local integration. I agree with the noble Baronesses, Lady Jolly and Lady Brinton, that people with disabilities and people of working age with care needs face a number of challenges. As indicated by the noble Baroness, Lady Jolly, we are taking forward a piece of work—led by the Department of Health and Social Care and the Ministry of Housing, Communities and Local Government—that will consider any issues specific to working-age adults and therefore not covered in the Green Paper. We will set out the results of this work in due course. I will write to the noble Baroness, Lady Jolly, to answer her specific questions on impact assessments and the consultations that have taken place, and place a copy in the Library.

As mentioned by a number of noble Lords, the recent Select Committee report, Long-term Funding of Adult Social Care, suggests that a tax on the over-40s or a social care premium similar to the German-Japanese model is the right way forward. The Government are committed to ensuring that everyone has access to the care and support they need, but we are clear that people should continue to expect to contribute to their care costs as part of preparing for later life. I can confirm for the noble Baroness, Lady Brinton, that the Green Paper will set out proposals for a sustainable system. Reforms must be affordable and fair across generations, including to working-age taxpayers. As noted by the right reverend Prelate the Bishop of Rochester, the Green Paper will bring forward proposals to build on the seven principles set out by the Secretary of State: quality and safety in service provision; whole-person, integrated care with the NHS and social care systems operating as one; better practical support for families and carers; and a sustainable funding model for social care supported by a diverse, vibrant and stable market. However, we are looking at the exact proposals in the Select Committee’s report and the Government will of course respond in due course.

Noble Lords did not mention the parliamentary commission, but I want to say that we welcome parliamentarians across the House and people in the NHS and social care coming together to look at how we can improve and make a more sustainable system.

The right reverend Prelate commented on informal carers and voluntary work. The Government are committed to continuing to support carers to provide care as they would wish, and to do so in a way that supports their own health and well-being, employment and other life chances. On 5 June, the Government published the Carers Action Plan which sets out a cross-government programme of targeted work to support carers over the next two years. As noble Lords have stated, a sustainable future for social care will simply not be possible without focusing on how our society supports carers. They are vital partners in the health and care system. I would be delighted to look at the Ministry of Justice system and learn from that experience. Indeed, as the Minister is here, I will ensure that that system is also drawn to his attention.

The noble Baronesses, Lady Brinton and Lady Jolly, and the noble Lord, Lord Beecham, also identified NHS mental health services. Of course, mental health services are important and are available for people with poor mental health, including carers. The improving access to psychological therapies programme provides treatment for adult anxiety disorders and depression in England.

My time is nearly up. I think I have answered most questions and as I said, I will write to the noble Baroness, Lady Jolly, about the two questions she asked. If there are any other questions outstanding, I will write to noble Lords and put a copy of my response in the Library. I conclude by thanking all noble Lords for their contributions and I look forward to us working together to find a long-term, sustainable solution—a sustainable way forward—to meet the care needs of some of the most vulnerable people in our society. I end by saying to the noble Baroness, Lady Brinton, that I was very sorry to hear Lucy and her family’s story. Those sorts of issues should not be in the system. I acknowledge that they are and we will try to sort them out. Thank you.