Local Authority Grants: Impact of Cuts

Baroness Thornton Excerpts

Thursday 9th December 2010 Lords Chamber

Moved by

[Baroness Thornton]

To call attention to the impact of cuts in grants to local authorities on the provision of social care and other public services; and to move for papers.

[Baroness Thornton]

My Lords, the reason why my noble friend Lord Beecham and I were keen to have this debate in your Lordships’ House was to underline the importance of considering social care and local government together in the context of what is happening and what is proposed in the NHS. That is why I am opening this debate and why my noble friend, with his reputation, knowledge and experience of local government, will close it.

We believe that joined-up thinking about social care for adults, the disabled and children is vital in the coming period, and I invite the Government to follow our example and ensure that that is what they do. I would like, for example, to see the Minister joined on these Benches by her noble friend Lord Howe in the next year or so as we debate these issues together.

Apart from anything else, it is quite clear from the way in which the rest of the world views these matters—be they individual citizens or the many organisations that support people—that it does not see social care, welfare benefits and the National Health Service as separate matters. The only way to look at what is happening on the ground is through the experience of individual citizens, and that is what I will do today. I have recruited an elderly gentleman with COPD—chronic obstructive pulmonary disease—to help me with this. It is a condition with which I am familiar, but I could as easily have chosen a younger person or someone with an illness such as stroke, a rheumatic condition or a variety of disabilities and conditions.

In the case of chronic obstructive pulmonary disease, the relationship with the GP is crucial, providing, as they do, attention and monitoring, to say nothing of ensuring the supply of oxygen and the drugs that are needed. Indeed, the GP is responsible—he is the gatekeeper—for recommending rehabilitation and exercise classes that are provided at present by the PCT and will help to keep our gentleman fit. This will help him to manage his condition and thus not be admitted to the local hospital unnecessarily. He may need adaptations to his home—for example, a walk-in shower—provided by social services, and needs-assessed benefits to enable him to stay in his own home for as long as possible. He might have a personal budget at some point, to be managed as part of his care package; and he may benefit from that personalisation and choice in his services. This is a complex but perfectly manageable condition. The successful outcomes achieved, and indeed the cost-effectiveness if this person can be kept both from emergency admissions to hospital and from admittance into a care home for as many years as possible, benefit the whole of his community.

The agencies involved are the NHS, the local authority social services and the DWP, among others. I know that we need to take account of his carers, his family, his friends, his community, his church, his voluntary organisations. Indeed, we know that millions of carers are vital to these people’s well-being and health. This person may well have family to provide support, succour and comfort for him. He may have friends and neighbours who look out for him, and he may have help from organisations such as Breathe Easy and Age UK, which know what challenges he may face and what information he may need; or he may not have any of those things.

We know that there are more and more of these kinds of people living in our community with these kinds of conditions. They are living longer because of improved healthcare, and they will need more support to continue living in the community. We know that demography and improved healthcare are the drivers of the size of this issue. The figures are as follows. By 2026, the number of over-65s will have risen from 8 million to 12.5 million; and it is projected that 1.4 million more older people will have potential care needs in the next 20 years. Unless we tackle the needs of our ageing population adequately, escalating care costs will cripple our economy. In a way, they will finish off the job that the banks started.

This is an issue of which we are all too aware. We were particularly all too aware of it towards the end of the last Labour Administration. That is why we worked hard to try to get cross-party, and indeed national, discussion and agreement on how as a nation we should tackle the huge demographic challenge that we face. We did not succeed, and I am not going to try to score points today about why that happened, and about who walked from the table and why. However, the current situation makes the results and the outputs of the current Dilnot commission very important indeed, and there is an onus on the Government to try to succeed and to build a consensus on the way forward. There is a need to involve all the stakeholders—I am sorry about that word, but I could not think of another one. All the interested parties, including the opposition parties, need to be involved in this national debate as we move forward.

Returning to my example, right now we need to consider which of the different elements that will keep our elderly gentleman at home and safe are at risk in the climate of perpetual revolution in almost every one of the areas that I have mentioned. Furthermore, we need to consider what might be done about that. I shall summarise the White Papers, Bills and other measures that are being put forward by the Government at the moment, and then consider how they might impact on our fictional elderly man. We know that the NHS White Paper will abolish the PCT that takes the strategic view of the care of pulmonary conditions in his town and that the local foundation trust has been working with it because of the need to keep people out of hospital. We know that the strategic health authority employs the pulmonary specialist, and that the PCT employs the pulmonary nurse. These bodies provide the funding for the rehabilitation and exercise classes. Although these classes do not cost much money, we do not know where it will come from in two or three years’ time.

It has taken several years to get to this point of co-ordination in this local area and to get the pooled funding in place, and we know that the PCT is now addressing the preventive health implications of this work. By the way, the rehabilitation and exercise classes take place in the community centre built and supported by the local authority; this centre might also be at risk.

We know that public health will go to the local authorities in the next year or so, and we on these Benches broadly support that initiative and the ring-fenced budget. We also know that a localism Bill is about to be launched in another place very soon. As I have said, we know that the Dilnot commission is to report and will result in a White Paper next year. We know that the health Bill will be with us in the new year when it emerges from Oliver Letwin's clutches, and will be introduced in another place.

Then we have the CSR and the funding cuts for local authorities. The spending review set out real-terms reductions of 28 per cent in local authority budgets over the next four years. This compares with the overall cuts of 8.3 per cent across all government departments. Local authority core funding from the DCLG reduces from £28.5 billion in 2010 to £26.1 billion in 2011, £24.4 billion in 2012, £24.2 billion in 2013, and £22.9 billion in 2014-15.

The impact on social care is already happening. From anecdote and report, we know that some local authority social services departments are already making support available only to those who score “critical” on the social care assessments. This is rationing through eligibility criteria. Returning to our elderly man, this could mean that, because he is mobile and independent, he will not receive the funding for the shower unit in his home. The attendant risks of falls and poor hygiene go with this. He may not receive the help that he needs to keep his home clean.

This is the reality of the problems facing the provision of social care for the foreseeable future. There are those who already believe that social care is in crisis. I recommend that noble Lords look at the blogs on the Age UK website. They are most instructive if one has any doubts about the level of anxiety that there is at large. In the case of my new-found elderly friend, as good as the GP supporting him might be, it is very unlikely that his commissioning contract will allow for the level of strategic planning necessary for many long-term conditions. I would therefore be very concerned about the transition of his care pathway for the next year or so. Even if it takes a year, at best, to sort out the necessary co-ordination of support for our COPD sufferer, he may well have deteriorated in that time. I would like to think that some thought has gone into precisely this kind of care pathway issue and the risks that the proposed changes pose.

Can the Minister confirm that she and her noble friends are undertaking this kind of exercise? If they are—and I really hope they are—would she care to inform the House how the Government will help to mitigate this transition to GP fundholding, the abolition of PCTs and SHAs, the cuts in social care, the changes to welfare, housing benefit regulations, which may place extra burdens on the local authority budget, and the introduction of the public health agenda? Does she acknowledge that slowing down a bit might actually help to mitigate the transition issues and might make a huge difference to citizens of all kinds?

In the middle of these changes it is entirely possible that our friend with COPD will deteriorate significantly and require hospitalisation with the attendant costs. We know that that happens to people with long-term conditions if there is a break in their support, their exercise or the information they receive and if their housing is disrupted. Where is the mantra, “No decision about me without me”, in this paradigm?

In many ways the Government have already—if inadequately—acknowledged these pressures by setting aside £2 billion to help local councils pay for social care. Of the £2 billion, £1 billion has come from the NHS budget, and the other £1 billion will be spread over four years of the spending review. The Local Government Association estimates that the extra resources are nowhere near enough to meet the rising demand for social care. The rise in costs could be as much as £6 billion by 2014-15. How will the Government help to meet this funding gap?

In a settled state of health and social care, such additional funding would be welcome. The fact that it comes from the NHS and local government budgets would be absolutely the right way forward. However, an extra £2 billion seen in the context of a wider 28 per cent reduction in local government funding can only lead us to the conclusion that adult social care will still face a serious challenge in funding because of increased demand.

However, cash alone is not the answer. Adult care and support goes way beyond the Department of Health and is bigger than council social services. We know that it must be linked to other council services, public sector partners, voluntary and community organisations and individuals. There needs to be an increasing emphasis on offering personalised solutions, giving individuals control of their funding and how it is spent. Councils have been striving to do that, and that approach is even more important.

However, and I looked at this with interest, I read on the ConservativeHome website a contribution from a member of the Conservatives’ flagship authority, Hammersmith and Fulham Council, urging 100 cuts in council services and demanding that there be cuts in care to looked-after children, that staff spending on older people and the disabled be reduced, and that youth services be slashed. I am sure that my noble friend Lord Beecham will have something to say about that. Hammersmith and Fulham is a case in point; not content to wait and see whether the big society can step in and look after the disabled or the young or the under-fives, it is in fact already closing down these facilities willy-nilly. I would like the Minister’s view on that website and on those 100 proposed cuts.

These cuts are too deep and too quick, and they are putting front-line services at risk. Combined with the proposals for the NHS, this is a time of great risk for those in the greatest need and with the greatest vulnerability in our communities. We have interesting times ahead, in the Chinese sense.

I apologise for not having gone into some detail about children’s services or indeed services for the disabled. I also regret that the noble Baroness, Lady Campbell, is not with us today and that we did not talk about portability. These are all serious issues, and I am sure they will be covered in this debate by other noble Lords. I close by thanking my imaginary elderly friend for his help in trying to explain what I think may lie ahead, and I look forward to the contributions from noble Lords who will speak today and from the Minister in answering this debate. I beg to move.

--- Later in debate ---

[Baroness Thornton]

I start by thanking the Minister and all noble Lords who have taken part in this debate. The noble Baroness’s first remark—that she wished she had had the noble Earl, Lord Howe, with her—is exactly right, because this did need both the local government and the health perspective to make it a rounded debate. I regard this as the start of the discussion about social care. We need to think about how we have these debates so that we can have the full range of government response that is required. This timing was perfect because we have identified in your Lordships’ House today the questions that need to be asked and that we need to keep asking about these issues. We have had several themes. We have had what I suspect is, from the coalition’s point of view, a lobby. The noble Lords, Lord Tope and Lord Shipley, are in there lobbying on the front-loading issue, backed up by my noble friend Lord Beecham. We have had individual stories, which are a very important way of addressing issues that cut across so many government departments. Unless you consider George’s story, the stories that the noble Lord, Lord Low, and the noble Baroness, Lady Hollins, described, and the issues for people with learning disabilities or whatever they are, you cannot test whether these systems are working, how they are evolving and how they are changing.

My noble friends Lady Sherlock and Lady Wilkins talked about children and the disabled. The noble Earl, Lord Listowel, gave a very moving account of the Sure Start centres in Hammersmith and Fulham. It will be a terrible tragedy if they are closed, as it looks like they might be.

We talked, as this House always does, about the partnership with the voluntary sector. The right reverend Prelate, the noble Baroness, Lady Barker, the noble Lord, Lord Adebowale, and my noble friend Lady Farrington emphasised the extremely important role of the voluntary sector. However, as the right reverend Prelate said, it is not a substitute for properly funded public services.

Then we talked about who pays and fairness. The noble Lord, Lord Adebowale, and my noble friend Lord Parekh raised these issues. I have to say that I was disappointed that the noble Lord, Lord Bates, and the Minister basically said—I paraphrase—“Well, actually, tough, because this is tough”. The noble Baroness also used the words, “We are all in this now”. Actually, we are not all in this now. Some of us are not in this, but the vulnerable, the poor, the disabled and the children are, and it is a grave problem. Some big questions were also raised by my noble friend Lord Lipsey.

We have raised many questions that still need to be answered. The Government are abrogating wholesale their responsibility towards some of the disabled, the elderly and the vulnerable in this country. We need to keep doing our job. We need to keep asking these questions, because that is what we are here for. I thank noble Lords and I beg leave to withdraw my Motion.

Motion withdrawn.