Department of Health and Social Care and Ministry of Housing, Communities and Local Government

Clive Betts Excerpts

Monday 2nd July 2018 Commons Chamber

[Andrew Lewer (Northampton South) (Con)]

I draw Members’ attention to my entry in the Register of Members’ Financial Interests; I am a vice-president of the Local Government Association. I am pleased to take this opportunity created by the estimates to discuss adult care funding, given that a large percentage of the funding that local government administers relates to it.

I have been part of the joint Select Committee inquiry on the future of adult care. Before that, I led a county council with responsibility for adult care that had an adult care budget alone of around a quarter of a billion pounds. I then arrived as an MP just in time for Northamptonshire County Council to fall over financially, due in no small measure to adult care costs; addressing local versus national responsibilities for that are perhaps for a different time.

Adult care funding is a very important issue, and the solution to it requires bold thinking. Although the better care fund and the general funding in the estimates are welcome, they do not represent a solution; rather, they represent a temporary patch. When I was deputy chairman of the LGA, we had a presentation from the King’s Fund in which it showed us reports that it had produced every year since 1999—this is very much a cross-party issue—saying, “This year must be the year that there is a solution to adult care funding.” That was in the last century. Integration is not the same as the NHS taking over. There will always be lines. With adult care, the next line would be housing, and I do not think anyone is suggesting that the NHS take over housing.

Colleagues have mentioned parity of esteem. Parity of esteem for employees is important institutionally. We speak a lot about the NHS. We are proud of it, and we are talking about its birthday, but often the NHS workers shade out the esteem that we need to give to social care workers and people who work in local authorities providing essential local services, particularly to the elderly.

[Mr Clive Betts (Sheffield South East) (Lab)]

I thank the hon. Gentleman for the part he played in the joint Select Committee report. He is absolutely right about that. Figures in the inquiry showed that for the same work, social care workers were paid about 29% less on average than workers in the NHS.

[Andrew Lewer]

I thank the hon. Gentleman for that comment. It is about pay, but it is also about conditions and remembering that the health economy is much more than the NHS.

I believe, however, that more tax is not the solution, even if hypothecated and ring-fenced as road fund licence and national insurance were in their time. It is not wholly in tune with Conservative philosophy to suggest that higher tax rates equal higher tax revenue, and there is economic theory to back that up. The Laffer curve, for which the British economy in the 1970s was in many respects the laboratory, indicates that when a certain tax rate is reached, revenue goes down, not up. We are high on the Laffer curve already: 41% of GDP is Government spending in the last recorded figures, compared with 38% in 1988-89 and 34.5% in 2000-01. This is not about whether we need more—we do—but how to get it.

In general economic terms, productivity gains, as my hon. Friend the Member for Mid Worcestershire (Nigel Huddleston) said, and GDP growth per head are key to more funding going into adult care. In specific terms, an insurance approach with some elements of the German model has a great deal to commend it. I was very pleased to see that option retained in the recommendations of the joint Select Committee report.

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[Mr Clive Betts (Sheffield South East) (Lab)]

It is a pleasure to follow the hon. Member for Yeovil (Mr Fysh). I concur at least with his points about local government funding and the pressures on councils in general with regard to their social care responsibilities. I want to address the points made in the joint Select Committee report. I thank the hon. Member for Totnes (Dr Wollaston) —she is my hon. Friend on this occasion—for her contribution to the report. Everyone worked together on it.

I do not think there is any doubt at all that funding is needed for social care. We cannot carry on trying to get this sorted out on an as-and-when basis every year. We need a long-term solution that people, and particularly the local councils that have to deliver the services, can rely on. Politicians are often good at identifying what needs to be done, but not very good at saying how it should be done. A great strength of the report is that I think it actually does say how this should be done. We say that we cannot carry on providing care in the same way and to the same level as has been the case over the past few years. We are say that, yes, there is a gap here and now, as identified by the Local Government Association, the King’s Fund and the Nuffield Trust. There are clearly demographic issues that are pushing costs upwards with regard to not merely the elderly, but people of working age with disabilities—there are demographics in both. We also have to accept that if we broaden the scope of people who get care, including people who have moderate needs, that will mean prevention and taking people out of the national health service. That is one way in which we can join up the two services very effectively.

We then have to look at quality. We all know of examples of quality failing at present. We know that the workforce are often on zero-hours contracts and the minimum wage—the same wage someone working on a supermarket checkout can get. We need to look at the long-term stability of the workforce, as well as their pay and conditions. We need to consider the viability of care providers, which are often giving contracts back or going out of business. All those issues require money. That is why, in the end, I have to say that although I very much support the long-term principle of care that is free at the point of delivery, according to need—that is one way in which we can join up health and social care in the long term—all the issues that I listed immediately need extra funding. It will therefore perhaps be some time before we can move to that free care system, but we can deal with clinical needs much earlier.

We can ensure that any money that is raised, whether through the national insurance funding model or the German model, is earmarked so that people can see that if they have paid extra, it goes towards social care. That came out very strongly from the citizens’ assembly. It is also about fairness and pooling risk, so that if everyone who can afford it pays a bit of inheritance tax, no one needs to find that the vast majority of their assets, including their home, has to go towards paying for their care. That really upsets people—it is the lottery of life, is it not? If someone has dementia and ends up in care for a long period of time, their home simply goes to pay for that. Most people feel that is really unfair, so if everybody pays a bit when they can afford it, no one would risk losing everything in the way that they do under the current system.

One of the strengths of our report that we have perhaps not made enough of is the fact that this is doable. It is practical and can be delivered in a reasonable period of time. As we have said, if business rates—75% of which are going to be retained by local councils in 2020—were kept in the local government system, that could address the local government problems to which the hon. Member for Yeovil referred. That can be done. We know that there can be a simple switch from the current intention of replacing public health grants and other things. If we consider the basis of a social care premium, either through national insurance or the German model, the structure is there to collect the money and would be relatively simple to adapt. As for the change to inheritance tax, again the system and framework are in place. They would be relatively easy to adapt and it could be done in a fairly short time.

Integration is a really important issue. We have not started from scratch and called for a whole new national health and care system, which could take years to bring about. We have said that, yes, health and social care need integrating and bringing together, as do housing services—most people who get social care do so in their home—and the link with public health, but that can be done within existing frameworks locally. The integrated care plans have been mentioned as one basis and there are the health and wellbeing boards. We have also heard about the Manchester model. All those models already operate and we can use them to bring about this practical integration at the point at which people need the service. This is not about a new bureaucratic framework, but about delivering services better for the individual.

Yesterday I was pleased to go on a 10-mile walk, raising funds for the Sheffield Hospitals Charity—that perhaps says something in itself. I went with my excellent consultants, Professor John Snowden and Dr Andy Chantry, together with their team from the haematology department at the Royal Hallamshire Hospital in Sheffield, who have given me such excellent care and treatment over the last year. I thank them all very much for that. There is a little secret that I have to let out though: John Snowden and Andy Chantry did a 50-mile walk over two days, and I just came on the last 10 miles of it. The commitment that they showed with members of their team demonstrates and is symptomatic of the approach that so many of our NHS staff have to the job they have to do—a job that we rely on them so much for.