Social Care

Baroness Wheeler Excerpts

Thursday 29th November 2012 Lords Chamber

[Baroness Wheeler]

My Lords, I, too, thank my noble friend Lady Pitkeathley for securing this debate and for once again giving us the opportunity to place a spotlight on the growing crisis in social care provision and funding as well as on the importance of developing joined-up services between the NHS and local authorities and within and across the range of services that local councils provide. As usual, my noble friend provides us with a clear strategic overview of the situation and of the impact of cuts to NHS and local authority budgets, as well as firmly rooting the debate in the day-to-day realities faced by thousands of people and their carers who are struggling to cope without the support that they need, often for help with basic everyday tasks, such as getting up, washing and eating.

We last debated social care when the Government’s long-awaited White Paper was published in July, setting out key law and system changes in the Care and Support Bill, and the process for pre-legislative scrutiny, on which we are about to embark, but, of course, sadly ducking the issue that needs to be addressed for any new system to be implemented and for it to work; namely, social care funding and Dilnot.

Dilnot was then widely seen to have effectively been kicked into the long grass by the Government’s in principle only decision. Since then we have had a “will they, won’t they” stop/start coalition dance on the funding issue. Over the summer, our hopes were raised by media reports about U-turns, rethinks, and Prime Ministerial determination to implement Dilnot. If you fast forward to this parliamentary Session, however, there is continued confusion, with the reappearance of the unattributed leaks from government sources about the issue not being a priority, and the Health Secretary himself telling the Tory Party conference that the costs were unaffordable, while, ironically, only a few weeks later, stating his ambition to make England,

“the best place in Europe to grow old”.

He was referring to recent welcome initiatives on dementia care, but with an estimated 1 million people likely to be suffering from dementia by 2021, and 600,000 family carers currently caring for people with dementia, surely the only long-term solution for ensuring that we can address their future care and support needs is to reach agreement on social care funding. Otherwise, the current system, or the new system post the Care and Support Bill, just will not be able to cope.

Most recently, we have yesterday’s Daily Telegraph report that the coalition Government are close to agreeing a cap on elderly care, which could form a centrepiece of the coalition’s mid-term re-launch next year. Like other noble Lords, I look forward to the Minister updating us on what is going on. Does he accept that the need for a long-term funding settlement for social care has never been more urgent?

The debate today focuses on the role of local authorities in the provision of social care, housing and other care services, and it is good for us to be considering council funding and responsibilities in this wider care context. Council responsibilities run across social care, adult and children’s, mental health and learning disabilities, disability support, education, housing, welfare, leisure and transport—the services that people needing social care use or interact with. Last week’s debate on services for people with neurological and other long-term health conditions, for example, underlined the complex care pathways across NHS, council and voluntary sector care provision that need to be better integrated, including health and social care with housing and welfare.

Huge responsibility is placed on local councils to provide or jointly fund these vital services, but we have heard from noble Lords how the scale of reductions across council budgets and in social care highlighted by previous speakers are having a major impact. ADASS and LGA estimate that £1.89 billion have been taken off adult social care budgets in the past two years and that there will be a likely overall funding gap of more than £16 billion a year in overall council spending through to 2020.

There is welcome evidence that the funding transferred from the NHS budget to support social care has helped to stimulate joint working, but the reality is that the bulk of this money is being used to offset cuts to services, although to their credit, surveys show that half of the councils in England are seeking to protect adult social care from the most drastic cuts they are having to make. However, Labour’s and other surveys show that this is predominantly being achieved by holding down residential care placements and agency home care hours costs, and we know that this is simply not sustainable. One large independent sector provider has said that the multi-million pound funding shortfall between the true cost of providing quality care that meets CQC standards and the fees paid by local authorities to care home providers has increased by 16% in just 12 months.

References have been made to this year’s survey by Labour, which showed an 11% fall in the past two years of the number of vulnerable, old and disabled people having home care services fully paid for by the local authority. Eight out of 10 councils provide free care only for people with substantial or critical need. It also found that the average charge for an hour of home care had risen over the same period by 10%.

Noble Lords have underlined the impact that local authority budget cuts have on hospitals as social care funding is squeezed. One often underestimated impact is on accident and emergency services, as more people come through because primary care is becoming less accessible and social care is reduced. The system often seems as if it is in danger of falling over.

The Minister has been asked many questions and I look forward to his response. I want to touch on a couple of those questions. On personalisation, with the personal budget deadline of April 2013 fast approaching, we need to assess any potential negative impacts on existing services such as the provision of daycare centres. I welcome the comments of the noble Baroness, Lady Barker, on the need for more economic modelling on new services, and the references of my noble friend Lord Warner to ensuring that money flows to support these new initiatives.

On children’s services, the right reverend Prelate the Bishop of Liverpool referred to a potential 20% of cuts in children’s services there, and the likely impact on the NHS. On residential care, I was struck by the key quality of care test suggested by my noble friend Lady Donaghy: namely, are residents’ comfort and well-being viewed as of less import than the potential for bed-wetting? The noble Baroness, Lady Campbell, summed up integration as a complex nut to crack. I think that we all recognise this. She rightly praised local authorities that have introduced innovation into care support, even while having to make what she called terrible decisions about care provision.

I would like, in the time left, to pick up on the crucial issue of mental health. Labour has pledged to do all it can to support achieving real parity of esteem between mental and physical health, as Ed Miliband made clear in a keynote speech last month to the Royal College of Psychiatrists. He described mental health as,

“the biggest unaddressed health challenge of our age”,

and said that it affects,

“one in six people across Britain”.

Local government is a key player in mental health, in shaping and commissioning services in social and residential care and in local community services such as advocacy, mental health outreach, befriending, drop-in groups and daycare provision, working with the NHS, community and voluntary sector providers.

As the chair of Blackfriars Settlement, a small local multi-service provider in the London Borough of Southwark, I can cite direct experience of how important the local authority role and support is, and how challenging and difficult it is for the voluntary sector to get funding to replace the reductions in funding. The settlement is one of a consortium of council funded voluntary organisations helping to deliver the borough’s mental health strategy. We have traditionally specialised in work with people with severe and enduring mental health problems, many of whom have been in the system for a long time. We are having to work hard to adapt our services to meet the new challenges on the ground. Our previous delivery model has been updated and adapted to provide a service menu for clients with personal budgets, and we are working hard to develop partnerships with local community groups on a number of projects. We have set up, with Big Lottery funding, a small social enterprise called Art to Print which provides employment and training in art and design production for local people with mental health problems, many of whom have never worked before. However, it is tough going and if we do not succeed in keeping these vital services going, our clients will just not have anywhere else to go.

The Centre for Mental Health underlines that social care input into mental health services is vital for recovery, but the information to measure and assess progress is hard to come by from local authorities because of the absence of systematic reporting on mental health spending and service provision at local level. The charity Rethink’s report, Lost in Localism, this year pointed out the difficulties of assessing the proportion of local authority social care spending on mental health, which is currently achievable only through freedom of information requests. Will the Minister outline any plans the Government have to improve data on local authority mental health spending and services which will help measure progress on how parity of esteem can become a reality?

There are significant reductions in parenting programmes’ budgets to support families at high risk, particularly parents who themselves have poor mental health. The British Association of Social Workers has estimated that around 40% of local authorities have removed, or are considering removing, mental health social workers from NHS-led mental health community and crisis teams. Action for Advocacy’s recent survey found that organisations providing advocacy services for vulnerable groups have had their funding cut by an average 36%, mainly by councils.

I was going to refer to a number of other things, but I see that time is running out. Therefore, I shall put two final questions to the Minister. Although the barriers to providing integrated services are well known, mental health has to date been one area where there have been long-standing partnership arrangements between the NHS and local authorities, including secondments and Section 75 agreements delegating functions to NHS trusts. Given this existing good platform, what are the Government doing to promote the continuation of this?

On parity of esteem, the NHS mandate commits the NHS Commissioning Board to deliver the Government’s commitment of at least 15% of adults with relevant mental health disorders having timely access to services with a recovery rate of 50%. What are the timescales, costs and funding sources for this? The Minister assured us that the mandate had been fully costed and could be carried out within these costs. Is 15% good enough?

Like the majority of noble Lords who have spoken in today’s debate, I hope that the Minister’s responses will show us that the Government understand the scale and urgency of the social care crisis and are prepared to take effective action in this Parliament to address it.