Local Government and Social Care Funding

Clive Betts Excerpts

Wednesday 24th April 2019 Commons Chamber

[Andrew Gwynne]

I will give way shortly, but I want to deal briefly with the issue of social care before I begin my concluding remarks.

The largest of the pressures on services remains the pressure on adult and children’s social care. According to the Local Government Association, adult social care services face a £1.5 billion funding gap next year, and £2 billion is needed for children’s services.

Given that the Cabinet are too interested in internal machinations, and given the absence of any leadership from the Prime Minister, we have yet to see the much promised social care Green Paper. In fact, this year’s April Fool revealed himself to be the Health Secretary after he missed his own new deadline of 1 April for the Green Paper—but no one was laughing, because that was the fifth missed deadline, following the summer of 2017, the end of 2017, the summer of 2018, and the autumn of 2018. Despite those delays, it seems that little progress has been made.

There is so much concern in the sector that last month 15 key organisations—including the LGA, the Society of Local Authority Chief Executives and Senior Managers, and NHS organisations and charities—were forced to write to the Government expressing their concern that Brexit was becoming a distraction from any action to deal with the real crisis that is affecting the services on which people rely.

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

Will my hon. Friend give way?

[Andrew Gwynne]

I will give way to the Chairman of the Select Committee.

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[Mr Betts]

There are clearly differences between the cuts made in different authorities, but there is a collective view in local government about the crisis in social care. When Councillor Paul Carter, chair of the County Councils Network and leader of Kent County Council, gave evidence to our Committee during our last inquiry into adult social care, he simply said, “We are approaching a cliff edge.” It is possible that some councils will not immediately follow Northamptonshire over that cliff edge, but it will not be long before they do unless there is a fundamental change in the funding of social care in this country.

[Andrew Gwynne]

My hon. Friend is absolutely right. Let me say to the Secretary of State that if he will not listen to the Chair of the Committee, he should listen to the leaders of his party’s own councils, who are saying precisely the same. There is a cliff edge, and no action that the Government have taken so far has done anything to remove it. It may have pulled a few councils back and given them a few years before they topple over, but unless we fundamentally change the Government’s approach to social care services, we will not be able to solve the crisis in local government.

For the first time in England, we have seen a standard £2,000 tax bill introduced by a Conservative council. We have also seen the costs of the failures of this Tory Government. For instance, the cost of the failure of Tory-controlled Northamptonshire County Council has been pushed on to local people because the Secretary of State allowed it to raise its tax above normal limits as it grapples with bankruptcy. Local people are paying the price of Tory mismanagement: that is what happens when the Tories do not fund local government and are in charge of the town hall.

Austerity is not over, but across the country Labour councils and councillors are showing that it does not have to be this way. Under the shadow of the present Government, Labour councillors are innovating, standing up against austerity, and protecting local services. They are the torch bearers for the new politics that we will see with the next Labour Government. On 2 May, there will be a clear choice: continued austerity with the Tories, or proper investment, fairness and a real change, with Labour councils making a real difference to the communities they represent.

We need a Labour Government because we need a Government who are committed to funding children’s services, funding adult services, funding neighbourhood services, rebuilding our communities from the grass roots up, putting pride back into civic professions, and encouraging our communities to grow and prosper. We will rebuild this country, for the many and not the few. I commend the motion to the House.

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[James Brokenshire]

I hope the hon. Lady will have noticed that, according to the latest figures, real wages are actually going up. I remind her of the fact that pay restraint across the public sector was a consequence of the mess that we inherited from the last Labour Government. I know that this has been difficult; it has been really tough and incredibly hard. Equally, we are determined to maintain the strong economic path for our economy and to ensure that our public finances are now back in the right space and not left in the fashion that the last Labour Government left them in. I am mindful of the essential role our local authorities play in helping the most vulnerable in our society, and I recognise the growth in demand in adult and children’s social care and the pressure that that brings.

[Mr Betts]

I am interested in the exchanges across the Chamber about which party has been the best, or perhaps worst, at the devolution of council funding. It was actually the Thatcher Government who introduced the capping of rates—it continued with council tax—taking away councils’ freedom to set their own business rates. Is it not the reality that neither the previous Labour Government, nor the coalition Government nor this Government have done anything fundamentally to increase the freedom of councils to raise their own funding at a local level? I hope that the Secretary of State will address that when we finally see his devolution framework.

[James Brokenshire]

I look forward to engaging with the hon. Gentleman and the Housing, Communities and Local Government Committee on issues relating to the devolution of business rates and so many other things. I profoundly believe in the merits and benefits of decisions being taken more locally and of local government having a sustainable position.

I am conscious of the number of Members who want to participate in this debate, so I will now make some progress.

Coming back to social care, £650 million out of the more than £1 billion of extra funding committed to councils at last year’s Budget will be going towards adult and children’s social care in 2019-20. Of that, £240 million has been allocated to ease pressures on the NHS, which comes on top of the £240 million announced in October to address winter pressures. The remaining £410 million can be spent on either adult or children’s social care where necessary to take the pressure off the NHS, meeting the request from local authorities for greater flexibility. Taken with the adult social care precept and the improved better care fund, the Government will have given councils access to £10 billion of dedicated funding, which can be used for adult social care in the three-year period from 2017-18 to 2019-20.

When it comes to protecting our children, we are investing £84 million over the next five years to expand three of our most successful children’s social care innovation programme projects. The projects will keep more children at home safely in up to 20 local authorities, but in the long run our work will ensure that our health and care systems are better integrated. That will be our most powerful tool in ensuring we have a sustainable approach in the years to come.

Returning to troubled families, which the hon. Member for Erith and Thamesmead (Teresa Pearce) rightly highlighted, I believe that our programme is helping local authorities to support families with complex needs and to improve outcomes for individuals. The programme has been a catalyst for local services, transforming how they work together, making them more integrated and cost-efficient, and reducing dependency and demand on expensive services. The results speak for themselves. The latest national programme evaluation shows that, when compared with a similar group, targeted intervention saw the number of children going into care down by a third, the number of adults going to prison down by a quarter, juveniles in custody down by a third, and 10% fewer people claiming jobseeker’s allowance. While I recognise that there is more to do, the results are a tribute to the tireless efforts of family workers, local authorities and their many partners in our public services and the voluntary sector. This is about so much more than the financial boost that someone can get from a regular wage. It is also about the pride and the dignity that comes with someone being able to take control of their own life.

The future of this country is not about an ever-growing collection of handouts and entitlements, but about growing prosperity and independence, and that equally applies to local government. This Government are working to build a more confident, self-sufficient and reinvigorated local government. With the end of the current multi-year deal in sight, we clearly need to take a longer view of how we fund councils as we move to a stronger, sustainable and smarter system of local government. This year’s preparations for increased business rate retention, a new approach to distributing funding between local authorities, and the upcoming spending review will also be pivotal. Important work is also under way with authorities and the wider sector to better understand service costs pressures.

For years, councils have asked us for more control over the money raised, and we are giving it to them through our plans to increase business rate retention to 75%. In the process, we will provide local authorities with powerful incentives to grow, and authorities estimate that they will retain around £2.5 billion in business rate growth in 2019-20 under the current system—a significant revenue stream on top of the core settlement funding. In addition to more control, councils want and need to see a clearer link between the allocation of resources and local circumstances, and our new fairer funding formula will ensure a more transparent link between local needs and resources and the funding that councils get.

I pay tribute to the leadership and creativity of our councils, which deliver high-quality services for their residents and efficiencies for the taxpayer. We are determined to give them the freedoms and flexibilities they need so that local government can continue to flourish and deliver vital services to meet the challenges and opportunities that lie ahead. As voters go to the polls at the local elections, this Conservative Government are providing a real-terms increase in spending power for local government and giving councils the freedoms to deliver for their local communities, and hard-working Conservative councillors are providing value for money for hard-working families and the quality services that their residents deserve.

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[Mr Marcus Jones (Nuneaton) (Con)]

It is a pleasure to speak in this debate. It is an important debate, so I thought the tone set by the Opposition spokesman at the start was a real pity. The shadow Secretary of State, the hon. Member for Denton and Reddish (Andrew Gwynne), ran through things in a very selective manner. It was almost as though he had been in a time machine and missed out certain periods and certain significant challenges faced by the country. He did not acknowledge the situation in which the Labour party left the public finances in 2010, with a deficit running at £150 billion a year and the Government borrowing £1 of every £4 that they spent—the taxpayer was footing the bill for that. Nor did he acknowledge that at the time, unemployment was rising and employment was going down, so people were losing their jobs.

Something had to be done, and the ship had to be steadied. We have seen the results of that, and we now have record employment, record low unemployment and rising wages. Achieving that has involved many difficult decisions. I, for one, know how hard local government has worked, the sacrifices that it has made and the sacrifices that people have made. I pay tribute to councillors across the country, and particularly to Conservative councillors, who operate better-run authorities at lower cost. I also thank council officers, who have worked extremely hard to deal with the challenges that we have faced. They have made a massive contribution to the reduction of the deficit.

I am concerned that so far, this debate has been one-sided. The hon. Gentleman talked about the reduction in revenue support grant and direct money from Government, and that has certainly happened. However, he did not mention the other side of the equation, namely business rate retention and council tax, and he tried to present a distorted picture of individual local authorities’ funding. The reality is that the authorities that he described as worse off actually have the highest spending power.

I am setting out the approach that the Opposition have taken, but I think they should instead have looked at the challenges and considered how we might address them in a sensible and measured way. I am certain in my mind that we need to put more money into local government, and the Government are starting to do so. Spending power is on the increase, and since 2017 up to £10 billion has been made available to local authorities to fund social care. The Opposition’s motion mentions £8 billion being put into social care during this Parliament, but the Government are already putting in more than that.

There are significant pressures on social care, whether it is children’s social care, where there are more looked-after children; adult social care, where we have an ageing population—that is a great thing, but it means that we have to support more people in their later years—or the important group of people of working age who require social care, such as adults with learning disabilities or people with complex needs who need support. Those groups are all growing in size, and we need to make sure that they are looked after for the future.

In addition to increasing demand, services face challenges from rising costs. The national living wage is going up, and companies now have to pay additional pension costs. That is a good thing, because it means that additional money is being paid to people who do the extremely important and difficult job of supporting the most vulnerable. We need to make sure that those employees are paid more, that they are trained well and that the job becomes more professional, so I welcome those things, but they present challenges. We need to work out in a sensible and measured way how we will pay for the additional provision that is, and will continue to be, required.

The Opposition spokesman talked about how the Labour plans for social care were blown out of the water by the Conservatives during the 2010 general election. I thought that was a bit rich, because that is exactly what the Labour party did to the Conservatives at the 2017 general election. If we are going to have a debate, let us have a sensible, measured and proper one, rather than just talking about how big our pile of cash is and listening to the other side say, “We will create a bigger pile of cash to pay for social care.”

We have to acknowledge who is going to pay for social care, and we have to get the balance right. We cannot expect young people who have just entered the labour market—people who are starting work and trying to make their way in life—to pick up the whole tab. We cannot expect older people who have worked all their lives and built up assets to lose all those assets because they need care. We have to look at the matter carefully and proportionately, and try to make sure that there is a balance. We must provide the support that people need but reward people for doing the right thing.

Clearly, local authorities provide much of social care, but we need to look at how that fits in with other social care provision. For example, I always find that continuing healthcare is a real bone of contention. The system is opaque and hard for relatives to navigate. It is hard for people to figure out why their relatives are not eligible when somebody in the neighbouring bed is eligible. It can take forever for a claim to go through. I have known a number of cases in which, unfortunately, relatives passed away some time before a continuing healthcare claim was settled.

[Mr Betts]

The hon. Gentleman is making an important point. Anybody who has dealt with families in that position knows that money may be suddenly withdrawn after a continuing healthcare review goes through. Very often, an elderly person will be transferred to another home because they can no longer afford the one they are in. Is that not something that we need to sort out in advance of a fundamental reform of social care? It is a significant problem.

[Mr Jones]

The hon. Gentleman knows a great deal about the subject, and I certainly think that the issue he mentions needs to be looked at, as does the wider system.

We need to look at how social care works in the context of the wider health system. We need integration; we have talked about integration for years, and it does happen, but we need a system that is simple enough for people—for relatives, in particular—to understand and navigate. We need to make sure that the different parts of the system work together. Public health must work with primary care, and our GPs must work well with our acute sector. We must all work together with one common purpose, which is to keep people out of hospital for longer. That is how to improve people’s quality of life and reduce the cost to the taxpayer.

I wish to mention a small but important example from my constituency: a doctors’ surgery called Whitestone Surgery. I declare an interest because I am a patient there. I mention Whitestone because it does fantastic work through its patient participation group and social prescribing. The patient cohort in the catchment area is made up of relatively older people, and many of the patients who go into the surgery are passported through to the PPG, which runs several activity streams, including an allotment, days out and the odd visit down the pub for a meal at lunchtime. All those sorts of activities are really improving the situation in the area by reducing social isolation and loneliness. As a result of that ongoing work, the surgery is seeing the prescription of a significantly lower amount of antidepressants and fewer people being diagnosed with dementia than at other surgeries with a similar patient cohort. Warwickshire County Council is considering the work at the surgery carefully with regard to expanding it throughout Warwickshire, and studies are also being undertaken to see what merit it has more widely. I am delighted that such important work is taking place in my area. It is a good example of what we need to do to support people.

Local government has done its bit and is doing its bit for the deficit, and we need to support local government going forward. Now that we have the public finances far more under control, we need to put more funding into other services, such as the police and schools. We also need to think about how funding is distributed, because currently the fairness is not there—for example, the people of Warwickshire get a raw deal compared with people in many metropolitan areas. We also need to think about the context and the effect that putting more money into public services has on our public finances. We need to think about the effect on what tax people need to pay. In the light of those things, the motion does not address the whole picture. It is based purely on a political slant and is not there to support the people whom everyone in this Chamber wants to support. I am afraid the motion is there just to score a few points, so I shall not support it.

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

As the Chair of the Housing, Communities and Local Government Committee, I think the importance that Select Committees have attached to the issue of social care is shown in the amount of time we spend on inquiries on the issue. We have recently published three reports on adult social care, the last of which was done jointly with the Health and Social Care Committee last year. They were all unanimously agreed by our Committee, and in the latter case by the Committees jointly. We are currently inquiring into children’s social care, with the report due out next week. Those four social care inquiries show how important the issue is for the Committee and for local government as a whole.

As a Sheffield MP, I have to comment on the fact that my city and constituency have received funding cuts that are far higher than the average percentage in the past nine years, since 2010. Like other northern cities, we have been disproportionately hit, as cities with the greatest problems and needs have seen the Government cut their grants by the biggest percentage.

Putting all that to one side, if I look at the wider context, I see real problems for local government, because as a whole local government has had bigger cuts by percentage than any other area of Government spending. That has united councils of all political persuasions in their concerns about the unfair effect those spending cuts have had on local government as a whole. This comes at a time when demand for the main local authority services—care services—has been rising. The number of elderly people has been growing, which has meant that the number of elderly people who need care has been growing. That is great, because people are living longer. The number of people of working age with disabilities—an element of care that we should not forget—has also been growing, which is another success. In percentage terms, the demand for children’s services is going up faster than demand for any other current aspect of local government spending, so that comes on top of what I have described, too.

Those three rising demands mean that despite the fact that more people are in need of elderly care, according to Age Concern some 1.5 million people are not getting it. The threshold has been raised such that people with lower and moderate needs are now excluded from the care systems. People are ending up in hospital who should not be there because prevention is not happening, and people in hospital are not being discharged as quickly as they should be. We see all these things happening as a result.

The pressures on social care are causing other issues. With rising demand and spending on social care, as the cake has shrunk, the proportion of it spent on social care has grown, so the amount spent on other services has proportionately been cut by even more. The National Audit Office has done the figures, and they were given to the Select Committee: cultural and related services have seen a 35% cut; highways services and transport have seen a 37% cut; housing services, including homelessness and private sector housing, have seen a 45% cut; environmental and regulatory services have been cut by 16%; and planning has been cut by 50%. Those are massive cuts to the basic services on which we all rely day to day.

I worry about all that, because although it is of course important that councils concentrate on care, most people in the country do not receive care for themselves or for people in their families on a daily, regular basis; they rely on other services. They are seeing their council tax bills rise and what they get for their money fall. That is a real challenge and problem for local democracy. People are paying more but not getting any more. We ought to be very concerned about that indeed. It needs to be addressed in the widest sense.

I refer to the comments made by Councillor Paul Carter, but people from the Local Government Association, the County Councils Network, the District Councils’ Network, London Councils, and SIGOMA, the special interest group of municipal authorities, have made similar comments. Every council organisation has said that the current situation simply cannot continue and that we need a fundamental change in the amount of money provided for local government in the next spending review. The Select Committee will do an inquiry into that, which will hopefully give Ministers the ammunition with which to badger and berate the Treasury when they have discussions at that level.

We know from the estimates, which no one from the Government has challenged, that by the end of the next spending review children’s services are likely to be £3 billion adrift of the funding they need. Social care for the elderly is already £2 billion adrift, with estimates that the average annual increase required to keep pace with demand is around £800,000. That takes us to around £7 billion adrift.

The quality of care is often forgotten about. We need not only to continue to meet the increase in demand, but to do something to improve quality. If demand is going to increase, we are going to have to recruit more staff, and if we recruit more staff, we are going to have to pay them and train them better, otherwise, we will not be able to retain them. So the costs are going to go up even further.

[Louise Haigh (Sheffield, Heeley) (Lab)]

I speak as a co-chair of the all-party group on social care. Next week, we are launching an inquiry into the professionalisation of the social care workforce. My hon. Friend is making an important point about recruitment and retention and the need for more funding. The pressures and demands on funding are leading to a reduction in the professionalisation of the workforce, and as a result to reductions in the quality of care.

[Mr Betts]

Absolutely. The joint Committee report made the point that the quality of care is so important, and we have to think about the quality of the workforce and how much we pay them. The average social care worker gets paid 29% less than someone doing a similar job in the NHS. That figure demonstrates the challenge that we face.

What are we looking at, then? We have recently had a few welcome sticking plasters of funding from the Government; but next time, we will need a very large bandage, not just a few sticking plasters, to put this issue right. We look forward to the Green Paper, at some point on the horizon. Perhaps the Minister can tell us about the timing for that when she replies, but even now time is now too short for there to be a fundamental change in funding arrangements. We are going to need a lot more of the same.

The two Select Committees recommended that, at the funding review, we take the £7 billion extra that will be in the local government system from the 75% business rates retention and, instead of using it to replace public health grants and other forms of grant, we put it back into the system to deal with the problems of social care. That money can be there and we will not have to change the system. That can be done. We also proposed changes to make the council tax system fairer and less regressive. We can do those things for the next spending review and make sure that a quantum of money—around £7 billion— is available for social care. That would then relieve the pressure on other council services.

We then looked at what the longer-term system should look like. Of course, we need better integration at a local level between the NHS and social care. This is not about a national system of care that replaces what local authorities do; it is about better integration at local level. We must bear in mind that, while it is important that the health service and social care are linked together, the other great join-up that we must have is between housing and social care. The majority of people receiving social care live in their own home, and it is vital that we get those services linked as well.

[Emma Hardy]

Does my hon. Friend agree that we also need to include education on support for children with special needs and disabilities?

[Mr Betts]

Absolutely. We need integration on that level as well. The point is that these services are better joined up and delivered at a local level. It is an important role that local government has to play, and it is why local government’s hand should be strengthened in these matters.

In coming to our conclusions about long-term arrangements, the joint Select Committee inquiry looked at two very important bases. We went to Germany to see what existed there. Essentially, Germany’s model involves an extra percentage on the insurance payments that it gets from the public. There was a cross-party agreement 20 years ago, and the rates in Germany have been raised with no dissent from the public or the parties. It is a system that works and that people agree with, because they know that the money goes into social care. That is what we looked at, and it helped form the basis of our conclusion.

We had a citizens assembly—it was a great experience. We selected around 50 people from all over the country. They met for two weekends in a hotel in Birmingham, and came to unanimous views about how we should deal with social care funding. The principles were clear: we should have a system similar to that of Germany, with a social care premium, as we recommended, but very importantly—the Treasury hates this—the money must be dedicated for social care. People are willing to pay more if they know where the money is going. That was a fundamental principle that was laid down. There was also the principle of universal and high-quality care, and the point was made that a well-paid and well-trained workforce was needed to deliver it.

We also said that there had to be fairness between the generations and that the social insurance premium should be paid only by people over 40. However, we thought that it was fair to say that people of pensionable age who work should also pay. Another issue that we felt needed to be dealt with was the unfairness of people losing their homes in some cases and of all their assets going to pay for social care. The suggestion was that we could bring in a floor and cap system to make sure that people do not pay anything up to a much higher level and do not pay any more beyond the cap. We can pay for that by simply taking a percentage of inheritance tax, so that everybody pays a bit towards the system. We thought that that was fair.

We also said that, ultimately, we want to work towards a system where social care—personal care—is actually free. We did not think that we were there yet, which was why we recommended these changes to begin with, but we thought that we could get there eventually. We said that the extra money coming in had to be on top of the existing local government system.

This is a very good report. Two Select Committees unanimously agreed how we should raise the money for social care in the future. I say to Members on both Front Benches: why bother with the Green Paper? They should produce the White Paper and get on with it. The solution is there. We have given it to Ministers and shadow Ministers. This is a very good proposal. Please get on and deliver it now for the future.

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[The Minister for Care (Caroline Dinenage)]

I start by recognising and paying tribute to those who care for us. It is a mark of our society how we care for the most vulnerable. Across the country, whether working in a care home, a person’s own home or at a day centre or another centre, so many dedicate their lives to caring for others. I also thank hon. Members from across the House who have taken the time to debate this important issue. We have heard a great number of passionate, measured, detailed speeches, and people have spoken about a range of issues and shown in-depth knowledge of and passion for their own constituencies.

My hon. Friend the Member for Nuneaton (Mr Jones) demonstrated the enormous knowledge one would expect from a former local government Minister in a wide-ranging speech that highlighted how most funding baselines take several factors into account, including deprivation. That is an incredibly important point. The hon. Member for Sheffield South East (Mr Betts), the Chair of the Select Committee, spoke passionately about the joint report that he and his Committee produced in partnership with the Health and Social Care Committee. He spoke about how it highlighted the importance of integration at a local level and the importance of housing, and he said it was important that the Government took that it into consideration and came back to the House with our Green Paper. I pledge to him that we will do that.

[Mr Betts]

The obvious question: when will we see the Green Paper?

[Caroline Dinenage]

We will bring it forward as soon as possible. The hon. Gentleman’s colleague, the right hon. Member for Exeter (Mr Bradshaw), made similar points about the importance of taking on board the hard work of the Select Committee, which came up with some interesting proposals for funding in particular.