Princess Royal Hospital, Telford

Clive Betts Excerpts

Tuesday 5th November 2019 Westminster Hall

[Mr Dunne]

My hon. Friend and neighbour makes a powerful case, as she always does when standing up for her constituents in the House. She has given some very moving examples of the messages that she receives and of the strength of feeling in the community that she serves. Does she recognise that the debate on acute services provision in Shropshire and Telford—that is the wider area, which extends to mid-Wales—has been ongoing for decades? In all the time that I have been a Member of Parliament, the difficulty arising from indecision about the reconfiguration of acute services has led to many services being provided out of county.

My hon. Friend mentioned stroke and cardiac services. Many of those are now provided in Staffordshire, so Shropshire has already lost services and people have to make long journeys. A reason for that is the difficulty in persuading enough clinicians with sufficient seniority and experience to provide a safe 24/7 service for our constituents. Although I completely understand her regret—half of my constituents would prefer to see the Telford services remain where they are—does she not see the opportunity to resolve the crisis and to ensure that we retain quality services for our combined populations? The area that she has focused—

[Mr Clive Betts (in the Chair)]

Order. I am sorry to interrupt, but this should be an intervention rather than a speech.

[Mr Dunne]

I am bringing my question to a conclusion, Mr Betts. There is an opportunity—about which I hope we will hear about from the Minister—to ensure continued A&E provision in Telford through the new A&E local service. It would be great to hear more about that.

Health Infrastructure Plan

Clive Betts Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

What is one more invitation to a meeting and a visit? I am of course very happy to accept my hon. Friend’s hospitality in his constituency and to meet him. He makes a very important point, which my hon. Friend the Member for North Dorset (Simon Hoare) alluded to, about the importance of community hospitals and community health facilities. That is exactly what is at the heart of the proposals that his county and his trust are developing, and that is exactly the right thing for them to be doing.

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

I am sure the Minister will agree that Sheffield Teaching Hospitals NHS Foundation Trust is an outstanding trust. It always comes in within budget and regularly has good or outstanding ratings for care, as I have experienced personally over the past two years. Disappointingly, Sheffield is not mentioned in this announcement. However, rather than my simply complaining, will he agree to meet me, the chair of the hospitals trust, Tony Pedder, and officials to discuss their very ambitious plans to renovate Weston Park Hospital in Sheffield, which already provides a top centre for cancer treatment and could be even better with the Minister’s help and the necessary funding?

[Edward Argar]

I am grateful to the hon. Gentleman for that note of deep positivity, which has not necessarily been universally heard from Opposition Members. Again, I would be happy to meet him.

Oral Answers to Questions

Clive Betts Excerpts

Tuesday 15th January 2019 Commons Chamber

[Steve Brine]

Yes, of course. Matters for the spending review are just that, but one thing that the right hon. Gentleman, as a former Health Minister, will have noticed—and probably welcomed—in the long-term plan is that we are going to look at the commissioning of, and therefore the funding flow for, sexual health services as part of the long-term plan.

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

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health and Social Care (Matt Hancock)]

Last week we launched the NHS long-term plan, which delivers on the vision for how the extra £20.5 billion that we are putting into the health service will be spent to get the best return for the taxpayer. The long-term plan is built on the principle that prevention is better than cure, and there will be a new focus on personal responsibility that reflects and complements the responsibility that the NHS has to us all.

[Mr Betts]

Looking to the last financial year, I am sure that the Secretary of State has seen a National Audit Office report that says that auditors gave a qualified opinion on 38% of local NHS bodies, expressing concerns about overspending and value for money. The Comptroller and Auditor General said:

“A qualification is a judgment that something is seriously wrong”.

Does the Secretary of State accept that many of these problems are down to local bodies struggling with the effects of austerity and real-terms cuts to their funding? Does he also accept that he is ultimately responsible for spending in the NHS, and does he accept responsibility for the totally unsatisfactory state of affairs that the NAO has identified?

[Matt Hancock]

That is a very big question, and the very big answer comes in the form of the £20.5 billion that is going in, but it is not just about the money. We also need to ensure that, at all levels, we strengthen the leadership capacity in the NHS, because the best hospitals that deliver the best services, that hit their targets and that are the best clinically are also the ones that have the best financial results. Strengthening leadership, making sure that the money is available, as appropriate, and ensuring that we deliver for patients are at the core of the long-term plan.

NHS Long-term Plan

Clive Betts Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

At the moment, as somebody transitions from children’s mental health services to adult mental health services, there is often a gap in provision as they register for the adult services. The purpose of having the new care plans up to the age of 25—similar to those, for instance, for care leavers that we have brought in in other legislation—is to make sure that there is a seamless transition from children’s mental health services to adult mental health services and not a gap that many, many people fall through.

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

Let me bring the Secretary of State back to the issue of public health. He seems to be saying that this is only a small grant and therefore not really very important compared with spending on the NHS as a whole. May I draw his attention to the wording in the long-term plan where it says that action by the NHS

“is a complement to, but cannot be a substitute for, the important role of local government”?

That role has been undermined by £700 million of cuts to public health grants in the past five years. Will he now recognise that if we are going to get a proper joined-up approach to ill-health prevention, he needs to give a commitment that in future the public health grant will increase, in real terms, at least by the same amount as NHS funding as a whole?

[Matt Hancock]

I certainly did not say that the public health grant was small—I said that it was £16 billion over the last spending review period. But NHS spending as a whole, by the end of this five-year funding settlement, will be £148 billion every year. Therefore, turning the firepower of the whole NHS to keeping people healthy in the first place will play a huge role in this. Of course, the public health grant has to be settled as part of the spending review, but the idea that that is the whole of everything with regard to preventing ill-health is missing the point.

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.

--- Later in debate ---

[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.

Adult Social Care: Long-term Funding

Clive Betts Excerpts

Thursday 28th June 2018 Commons Chamber

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

I begin by thanking the Backbench Business Committee for allocating time today for me to present the Housing, Communities and Local Government Committee and Health and Social Care Committee joint report on long-term funding of adult social care.

In 2017, the then Communities and Local Government Committee undertook a lengthy inquiry into adult social care. We concluded that spending on social care would need to rise significantly in the coming years, and that after successive failed attempts at reform, political parties across the spectrum needed to be involved in the process of reaching a solution. With that in mind, we returned to the issue in a joint inquiry with the Health and Social Care Committee, aiming to identify funding reforms that would be supported by the public and politicians, and to feed its findings into the Green Paper. I thank all members of both Committees for the constructive role they have played, and particularly the Chair of the Health and Social Care Committee, who is so knowledgeable on these matters and with whom it has been a genuine pleasure to work on this inquiry.

To find out the public’s views on how social care should be funded, we commissioned a citizens’ assembly, which I understand is the first held by the UK Parliament. Following a process of learning, deliberating and decision making, which took place over two weekends in April and May, a representative sample of nearly 50 members of the public was asked how best to fund social care. We have listened carefully to the assembly members’ views. They have been vital in informing our thinking, and are reflected throughout our report. We have taken the unusual step of specifically addressing our recommendations to both sides of the political divide, asking that both Government and Opposition Front Benchers accept them.

What are the challenges facing social care and what funding is required to address them? The critical state of social care and the very serious consequences for people who receive care, and those who do not, and their unpaid carers and families, as well as the NHS, is well documented. The evidence was clear that the combination of rising demand and costs combined with reductions in funding to local authorities has placed the social care system under very great and unsustainable strain.

Despite the welcome additional funding provided by the Government in recent years, local authorities face a funding gap of around £2.5 billion in 2020. This has been confirmed by the National Audit Office, the King’s Fund and the Nuffield Trust, as well as the Local Government Association. The consequences are extremely serious and widespread, leading to people going without the care they need, and the time and quality of care not being sufficient for many who receive it, leading to unpaid carers having to step into the breach and placing significant pressures on care providers and the care workforce.

A witness to the inquiry, Sir Andrew Dilnot, chair of the 2011 Dilnot commission, told us that the system was consequently now at risk of “fairly significant disaster”, which were very strong words indeed. We concluded that considerable extra funding in the order of many billions of pounds would be needed in the coming years for the following reasons.

We need to fill the funding gap that I just referred to and we then need to provide additional funding to meet future demand. The personal social services research unit at the London School of Economics projects that spending on both social services for older people and younger adults will more than double by 2014, even without the improvements to the service that we suggest. It is also important to meet the care needs of a wider group of people—not just those whose needs are critical or substantial, but those who have moderate needs that are currently largely unmet. Age UK estimates that around 1 million who need care currently do not get it. Finally, and very importantly, we need to ensure that the care provided is good care from a stable, well-paid and well-trained workforce and viable care providers.

The difficult question for the Government and the Opposition to grapple with is where the additional funding for adult social care and social care for people of a working age with disabilities should come from, what it should be spent on, and how the care should be delivered. On care provision, we are strongly of the view that the responsibility for the delivery of social care should continue to rest with local councils at a local level. Social care provision should not, however, be seen in isolation. There is a need for better integration at a local level particularly within the NHS, as well as housing services. After all, most people receiving care get it in their homes. Integration should be seen not as a matter of bureaucratic convenience, but as a way of improving the care that individuals receive. The integrated care partnerships and health and wellbeing boards have an important role to play in that.

Our citizens’ assembly members expressed strong support for a social care system that, like the NHS, is free at the point of use. We acknowledge that this would increase costs substantially and be unlikely to be affordable immediately. We believe, however, that it is an ultimate objective for the personal care element of social care to be delivered free to everyone who needs it, and that accommodation costs should continue to be paid on a means-tested basis. This direction of travel should begin with the extension of free personal care to those deemed to have critical needs.

Now for the important question: where should the funding come from? Given the scale of the additional funding that is likely to be needed, which I have explained, we recommend that a combination of different fundraising measures are needed at local and national levels. At a local level, there should be a continuation for the foreseeable future of the existing local government revenue streams. We recommend that, in 2020, this funding is enhanced through using the additional revenue from 75% business rate retention, rather than the Government’s proposal to use the money to replace grants such as the public health grant. In the medium term, we recommend a reform of the council tax valuations and bands to bring them up to date. As other funding streams develop, the contribution from council tax and business rates to social care funding could fall, allowing councils to better fund other important services.

However, local government funding will only ever be one part of the solution for social care, given the scale of the challenge. It is clear that extra revenue will also need to be raised nationally to be spent on local provision. The citizens’ assembly was strongly in favour of any extra taxation being earmarked, wanting the clear assurance that the money raised would be spent on social care. We therefore recommend that an additional earmarked contribution, described as a “social care premium”, should be introduced, to which employers, as well as employees, would contribute. For fairness, it would be paid on earnings above a threshold and with the current national insurance limit lifted. We suggest that this premium could either be as an additional element to national insurance, which would ensure the accountability desired by the public and the citizens’ assembly, to be placed in an appropriately named and dedicated fund, and regularly and independently audited, or be paid into independent insurance funds, similar to the German model.

We strongly believe that a funding solution must fall fairly between generations and therefore recommend that those aged under 40 should be exempt from the social care premium, and that it should also be paid by those who are still working after the age of 65. We also recommend that a specified additional amount of inheritance tax should be levied on all estates above a certain threshold and capped at a percentage of the total value. This is intended to avoid the catastrophic costs for some individuals, who currently have to lose the vast majority of their assets, including their homes, to pay for care costs. It would pool the risk and spread the burden more fairly, a key recommendation of the citizens’ assembly. My view is that, if everyone who can afford it pays something, no one should have to lose everything.

After successive attempts at reform, the forthcoming social care Green Paper must be the catalyst for achieving a fair, long-term and sustainable settlement. It also ought to recognise the care needs of those of working age with disabilities, as well as the care needs of the elderly. To ensure that, we recommend that our work should now be taken forward by a cross-party parliamentary commission.

I say, on behalf of both Select Committees, to Government and Opposition Front Benchers that if we, on a cross-party, cross-Committee basis, can unanimously reach difficult decisions and make clear recommendations, can they not do the same? Use our proposals as a basis for building the wider consensus that we need to create a long-term, sustainable funding solution for those who need care now and in the future.

[Dr Sarah Wollaston (Totnes) (Con)]

I thank my co-Chair for the dedicated work that he has put into this joint report, as well as all members of both Committees and our wonderful supporting Committee teams. Like him, I thank not only all those who took part in the citizens’ assembly and those who advised and supported them, but the very many people, and their loved ones, who depend on social care, who wrote to us and whom we visited on our Committee visit. They told us moving stories about the level of unmet need and the consequences, both for themselves and their families.

The situation could not be more stark. As we approach the 70th anniversary of the NHS next week, would my hon. Friend say more about the impact on the NHS if we fail to address the unmet need in social care?

[Mr Betts]

I thank the hon. Lady, the Chair of the Health Committee—I think on this occasion, my hon. Friend, because we have worked on a friendly basis on this inquiry. She is absolutely right. One of the important recommendations is about trying to extend the scope of care provision to include those with moderate needs. If we provide care for them, it is quite likely that we will stop them getting into the substantial and critical phase and ending up in hospital in the first place. In terms of the NHS, it is about stopping people getting into hospital by getting them proper care and having care available for people in hospital, so that they do not have delayed discharges. In those two ways, that can be beneficial. Of course, we can also join up services. Can the NHS district nurse who goes into someone’s home and looks at their needs not assess their care needs at the same time? Can we not get that sort of joined-up approach?

It was remiss of me not to thank the staff, as the hon. Lady did, and I will name Laura and Tamsin. The work they did on this was exceptional. To produce a report of this quality in the time available was absolutely first-class, and we should congratulate them on it.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I thank the Chairs and the members of the Select Committees for their work on the report, and my hon. Friend the Member for Sheffield South East (Mr Betts) for his statement introducing it. The key points from the report for me are that in its present state the care system is not fit to respond to current needs let alone predicted future needs, and that spending on social care needs to rise. Next week is the 70th birthday of social care, as well as of the NHS, but there is no funding settlement and no celebrations for social care. Does my hon. Friend agree that the time for a funding settlement for social care is now or at least soon, not years down the road?

[Mr Betts]

Yes, I completely agree with that. We have got to get on with it. If we agreed everything now, it would probably take two or three years to put it in place. That is why we suggested the stop-gap measure of the extra business rates in 2020 being made available for local authorities. We thought that was a very important solution. If we get it right, we can have stability for the long term. The Germans did this over 20 years ago. They have a stable system and it works. They have just put extra money into it with general public support, because everyone trusts the system. That is the position we have to get to.

[Andrew Selous (South West Bedfordshire) (Con)]

I, too, pay tribute to the hon. Member for Sheffield South East (Mr Betts) for the way he chaired the Committee; it was very collegiate and consensual, which really helped us in our deliberations. He may remember that when we visited a care home the residents and families of those receiving care accused this Parliament of a lack of courage for not having addressed this difficult issue for so long. Does he agree that there is a real sense of urgency? When the Government produce a Green Paper in the autumn, we need to get on with it. There is no reason why we cannot move this forward quite quickly. As he said, Germany has done it since 1994. Frankly, it shames this country that Germany has had a good system in place for so long, while we have not.

[Mr Betts]

I completely agree. If we are still talking about this in two or three years’ time we will have failed. We have to get some decisions and get on with it. As politicians, we are often very good at coming up with ways to spend money. In this report we have actually come up with ways to raise money, which is the difficult part. We have done the heavy lifting for both the Government and the Opposition Front Benches. We now say, “We’ve handed the pass over to you. Get on and run with it and make it work.”

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I, too, welcome this cross-Committee report and note that it aspires to provide free personal care, as we have in Scotland, and to extend it to those in need under 65, which we will start next April. While that has significant costs, does the hon. Gentleman agree with the assessment of the Scottish experience by the King’s Fund and the Health Foundation, which suggested that overall it saves money, because people can remain in their own homes rather than care homes and rather than being admitted to hospital?

[Mr Betts]

I saw the King’s Fund report and I have seen the analysis. That was an aspiration eventually. However, the Select Committees’ felt that the immediate pressures of the funding gap, which will grow if we do not do anything about it—because of the demographics over the next few years, the fact that we are not meeting the needs of those with moderate care needs, the fact that we are not paying our workforce properly and that many care providers are in financial difficulties—mean that those issues have to be addressed and then, eventually, we can move on to the free care aspiration set out in the report over the longer period.

[Mr Philip Hollobone (Kettering) (Con)]

I congratulate the hon. Gentleman on his statement, and both Select Committees on their report. He said that if everyone contributes something, we should be able to sort out the funding problem. He put great emphasis on the need for a social care premium and praised the German model. In the report, he specifically says that under 40s should be exempt from the social care premium. The argument from the older generation will be that they have paid taxes throughout their lives, so why should they be unfairly burdened? What is the experience in Germany with regard to the social care premium? Does Germany exempt people under 40?

[Mr Betts]

It is a difficult decision. Germany does not exempt people under 40, but there are other tweaks to the system. For example, people without children pay extra and people who are not working pay extra in retirement because they do not have an employer contribution. We have not just mirrored the German system absolutely. We have taken elements from it, which I think is quite right. Japan’s system is not dissimilar and it does restrict payments to those over 40. We have looked at different systems. It is a challenge, but in the end we felt that there were considerable pressures on younger people at this point in time: family pressures, housing pressures, job pressures. We therefore felt that to start at 40 was a reasonable benchmark, bearing in mind that for the vast majority of people it will mean that they will pay into the care system at some point in their lives.

[Mr Ben Bradshaw (Exeter) (Lab)]

Is it not remarkable, given the failure of successive Governments to grasp this nettle, that two cross-party Committees with Members holding widely different views and ideologies managed to agree a unanimous report? Does that not make it even more incumbent on the Government, given the acuteness of the crisis, to take this report very seriously and to implement its recommendations as quickly as possible?

[Mr Betts]

I completely agree with my right hon. Friend. The fundamental question is: if we can do it, why can’t they? We have done the difficult part. We have set out a framework. Those on the Government Front Bench may not want to accept every detailed element of it, but it is there to work from. It should mean that we ought to be able to get to a consensus and an agreement about what should be done in a much shorter period of time than the years the Government were perhaps initially contemplating.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I thank both Chairs for the very constructive nature of the inquiry and the discussions around it, which have led to the report. We need to depoliticise this issue—that is critical—and I believe we have done that in the report. Does the hon. Gentleman agree that one of the most important parts of the report is not just the money it would raise, but how it would be delivered? Individuals who are in receipt of care can direct the payments to their loved ones, the people who know them best and can give them the best possible care. That care being delivered by the people who understand them best and love them the most will strengthen the social fabric of our communities.

[Mr Betts]

Yes, I completely agree. I could not refer to every specific recommendation in my statement. The hon. Gentleman is referring to paragraph 78 of the report, where it states that instead of care being delivered to people, they could receive a cash payment so their family members could do it in a way that suits them best.

[Liz McInnes (Heywood and Middleton) (Lab)]

I congratulate my hon. Friend on the report and on the work of the Committees to deal with this very difficult subject. In my constituency, we have a problem with nursing care homes closing and being converted into residential care homes, because of a problem with recruitment and retention of nursing staff. I am glad he mentioned that the care being given has to be good quality. Will he say how the increased funding would help with that situation and give us the nursing home beds we need?

--- Later in debate ---

[Mr Betts]

It is about getting a well-paid, well-trained workforce. NHS staff who do a similar job get paid about 29% more. I am not saying they are well paid, but clearly social care staff are not well paid. That funding gap has to be addressed and people have to be properly paid. The Committees signed up to the Unison charter for the workforce in social care.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I congratulate my hon. Friend and the hon. Member for Totnes (Dr Wollaston) on their leadership on this issue. The inquiry’s report provides incontrovertible evidence of the crisis facing social care funding. I particularly welcome the recommendation that social care should be provided to those who need it free at the point of delivery, and the very practical recommendations for raising the additional funding we so urgently need. I come to the House from a meeting of supported housing providers, which provide housing for older people in my constituency and elsewhere in Southwark. All highlighted to me the increasing numbers of referrals they receive from older people who are being made homeless and suffering problems in the private rented sector. This problem is growing. The report highlights the importance of housing for the delivery of a sustainable social care system and I wonder whether my hon. Friend might just say a little bit about that now.

[Mr Betts]

Absolutely. Most people receive care in their own home. The Committee’s report on housing for older people looked at the nature of the home. It showed the importance of the warmth of the home and the ability to get around the home—trip hazards and so on. Means-testing for the disability facilities grant relates to means-testing for care provision and other benefits, so they need to be properly integrated. Another recommendation in the report was that where means tests exist, they need to be joined up together.

[Nick Smith (Blaenau Gwent) (Lab)]

The economics of the sector are fluid. Does my hon. Friend agree that there has been a high turnover of ownership of care provider organisations? The Government need to monitor buyouts in the sector carefully, so that those living in care do not worry about who owns their home.

[Mr Betts]

Absolutely. The Committee did not discuss the ownership of care homes, but we did discuss the number of homes that had gone out of business or had been contracted back to local authorities. This is an ongoing and very real problem. We need not just a well-paid and well-trained workforce but viable care providers, so the money needs to be there for the providers as well as the workforce.

[The Minister for Care (Caroline Dinenage)]

I thank the Chairs, the members and the staff of both Committees, and congratulate them on producing an exceptional document. I also congratulate them on their extremely collaborative approach to their work, which is incredibly refreshing. For too long this issue has been used as a political football to be kicked around, but I am afraid it is too late for that now. We no longer have that luxury; we must reach a sufficient settlement. As other Members have pointed out, successive Governments have failed to address this issue. The Committees’ consultative, collaborative and constructive approach has been very positive and has been warmly welcomed, as, indeed, has been their engagement with the citizens’ assembly.

As has been made clear by the Secretary of State for Health and Social Care, we want to integrate plans for social care with the new NHS plan that the Prime Minister announced recently. It would not make sense to publish it before the NHS plan has even been drafted, so our Green Paper will be published at the same time as the plan. It will cover the Government’s proposals on a wide range of social care issues, including, but not limited to, the need for the social care market to be sustainable for the future. It will also build on policies such as our “Carers action plan”: we will, for example, consult on proposals to provide better support for unpaid carers.

The report will be incredibly valuable to our work. It will enhance our plans for the Green Paper, and will ensure that it can offer people a sustainable future and the knowledge that as they approach their later years, they will do so in security and safety and with quality provision.

[Mr Betts]

Again, I thank all the members and staff of the Committees for their work. The challenge now lies with the Government and with Ministers. There should not be any more long grass out there to kick things into. We want to see Government and Opposition working together and starting to make the difficult decisions that need to be made for the benefit of the people who need the care, both the elderly and those of working age.

Social Care

Clive Betts Excerpts

Thursday 7th December 2017 Commons Chamber

[Jackie Doyle-Price]

I thank my hon. Friend for that point because although, quite rightly, we focus on the challenges and difficulties of this issue, a hell of a lot is going right. As she says, the Care Quality Commission found in its recent “State of Care” report that 80% of institutions were good or outstanding. That is a pretty good deal for a sector that is constantly and publicly criticised.

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

I welcome the Green Paper, and I hope that we can build cross-party consensus for the long term. However, any change will be years away from that Green Paper. The problems are here and now for local councils, and the Minister simply did not deal with them in her statement. The Local Government Association estimates for next year a funding gap of £2.6 billion on a cross-party basis. The Competition and Markets Authority states that care homes are failing because local authorities do not have the necessary resources to pay the fees. What will the Minister do about that? Where is the money to ensure that an inadequate social care system does not get even worse next year?

[Jackie Doyle-Price]

I welcome part of the hon. Gentleman’s comments. He is right: one reason we are at this stage is that the absence of long-term security means that some of these issues are crystallising rather more quickly than they ought to. We have made more money available to local authorities, but clearly they, more than any others, are desperate for a solution. It is incumbent on us all to hold a constructive discussion about the solutions to this issue. I am well aware of the challenges. The hon. Gentleman highlighted the CMA report, and it contains a lot that, frankly, did not surprise me. In the new year we will be bringing forward a response that deals with some of the issues raised.

Adult Social Care Funding

Clive Betts Excerpts

Thursday 6th July 2017 Commons Chamber

[Steve Brine]

My hon. Friend is a doughty champion for her Eastleigh constituency, and I also represent part of the borough. What she says surprises me, but I am sure she will raise it in the national debate in the months leading up to next May’s borough council elections.

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

In March, the Select Committee on Communities and Local Government agreed a report on adult social care. We called for significant extra funds in the short and medium term, but we said that, in the long term, a lasting solution will be found only through cross-party working. The Minister seems to agree in principle, but will he confirm: that he will engage with Opposition Front Benchers and other parties on the consultation’s terms of reference; that he will fully involve them in the consultation; that he will approach the consultation with an open mind, and not rule out any alternatives; and that the Select Committee will be involved in the consultation?

[Steve Brine]

I confirm that there will be the widest possible engagement across the House and across the sector, including with the Select Committee that the hon. Gentleman may or may not be in charge of in the next few weeks.

Health and Social Care Budgets

Clive Betts Excerpts

Tuesday 14th March 2017 Westminster Hall

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

It is a pleasure to follow the two Select Committee Chairs, my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) and the hon. Member for Totnes (Dr Wollaston); we have worked very closely on these issues. It is also a great pleasure to see so many other colleagues in the Chamber today. It is obvious that social care and health issues are now coming very high up the agenda, which is absolutely right.

I will refer to the report that the Communities and Local Government Committee has just produced, “Adult social care: a pre-Budget report”. In the next few weeks, we will produce a longer report about longer-term issues in social care. To begin in the here and now, the Committee welcomed the fact that the Government have allowed local authorities to increase the precept in the next two years and have encouraged local authorities to take up that offer, while still recognising that there are challenges around the fact that the precept raises very different amounts of money in different local authority areas. We asked for an immediate further injection of £1.5 billion, so it is welcome that the Chancellor announced an increase of £1 billion, even though £1.5 billion would have been more welcome—I think that is how the Committee will look at that.

Recognising that that would not be a permanent solution for this Parliament, however, we asked for the National Audit Office to be given the responsibility to look at what is required for the rest of this Parliament—the further two years of the spending rounds—to address the issues in social care. Those issues are very real, with an increase by a third in the number of people in their 80s or 90s over a 10-year period, with local authority spending on social care down by 7% since 2010 in real terms, with the increase in the minimum wage, with the Care Act 2014 and with all these other pressures.

[Paul Blomfield (Sheffield Central) (Lab)]

Does my hon. Friend recognise that there are two groups of victims of the crisis in social care? They are not only those who depend on the services, but those who work in the sector and who face, for example, widespread non-compliance with national minimum wage legislation, which the Government are aware of but not acting on. Does he agree that needs to be recognised in a future settlement? We need a paradigm shift in how we view care work.

[Mr Betts]

We will return to the proper training, long-term commitment and pay of staff in the care sector in our Committee’s further report, but we certainly had evidence to that effect.

We need another way of dealing with the funding gap for the rest of this Parliament. For the longer term, I very much welcome the announcement of the Green Paper, but I echo the comments of the two previous speakers. We need to get cross-party agreement on a sustainable, long-term settlement that will last not merely for the next Parliament, but for several Parliaments after that. There are major challenges. I agree that we should look at health and social care together, but there are fundamental differences in governance and accountability between the two systems, so how do we resolve that?

We should certainly look closely at what is happening in Manchester, to learn about the devolution deal there and how the two can work together within the same governance structure. Personally, I feel that losing the local accountability that the social care system currently has and simply centralising the whole system would be a mistake. That would take us in the wrong direction, so it is important to look at what is happening in Manchester. We have two very different funding systems. We have the health system, which is free at the point of use, but I do not think that anyone suggested in evidence that we could fund social care on exactly the same basis. We will have to consider something slightly different to fund social care, but how the two systems fit together will be a challenge.

If we are considering the future for social care funding, we should bear in mind that currently we have a mixture of funding. We have some central Government funding, local authority funding and the personal contributions that come through people paying for their care, particularly in residential homes, and what happens to their estate when they die. Will that mean a bit extra from those different elements—a bit more from central Government, local Government and personal contributions—so that the total whole grows? However, the Government have said that they will introduce the Dilnot proposals in the next Parliament—that is what the Minister said to us—which will cap and reduce the contributions that may come in from people’s private estates when they die, so does that mean more money from somewhere else?

I am sorry that the Chancellor did this, because everything should be on the table, but he ruled out a different way of taxing or receiving contributions from people’s personal estates when they die: taking a percentage of everyone’s estate. Currently, people contribute their estate if they end up with dementia and go into a care home, but if they have a heart attack, they tend to contribute nothing. Is that system fair? Is that a challenge we must look at? Even with Dilnot, the £72,000 limit would take most of the estate from a small house sold when someone in my constituency dies, but it would be only a fraction of the value of a property sold in the more expensive parts of London. Is that fair either? Do we simply scrap the whole thing and go on to a German system of social insurance?

The Communities and Local Government Committee went to Germany to have a look at its model. There are pros and cons to it, but we really need to put everything on the table and not rule out any possibilities. We need something that we can, in the end, reach cross-party agreement on, recognising that the social care system will probably be different in its funding from the health system. How they can fit together and be governed together will be absolutely crucial to the success of a long-term settlement, when we eventually reach one.

[Mr Adrian Bailey (in the Chair)]

I remind Back-Bench contributors that there is a three-minute time limit. I call Anne Marie Morris.

Health and Social Care

Clive Betts Excerpts

Monday 27th February 2017 Commons Chamber

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

The Communities and Local Government Committee is currently undertaking an inquiry into the funding of social care. We have not produced our reports yet, so anything I say should be taken not as the Committee’s considered view but as some of my own reflections on the evidence we have heard so far. I hope it will not be too long before we can provide a report for Members to look at on the immediate issues of social care, and then, in due course, we will go on to look at the longer-term issues as well. We have taken evidence from a variety of different organisations, including councils, care providers, directors of social care, the Nuffield Trust, and the King’s Fund. Carers and care providers, as individuals, have related their personal experiences to the Committee.

As a constituency MP, it is not terribly surprising to have heard what I have heard today. Unfortunately, as an MP, like everyone else here, I am sure, I see only the tip of the iceberg of problems. Cases about the nature, and number, of social care failings have undoubtedly been increasing in my surgery, my postbag and my emails in the past two or three years. Some of the cases are quite horrific. A council that has to cut its budget on social care does so by going out to the private sector, or agencies, and substituting their services for the service that the council used to provide through directly employed staff. The way in which those services are delivered—often the simple failure of people to turn up and provide the care when it is promised—causes real and increasing problems that I am certainly seeing as a constituency MP.

This is not surprising. The Chair of the Health Committee referred to the fact that we have had a 7% cut in real terms in spending on social care since 2010. Local authorities’ grants from central Government have been reduced by 37%. Councils have tried to prioritise social care—the evidence for that is absolutely clear—but they have not been able to protect it completely from the cuts. That is the reality. On top of that, not only has the money been going down but the number of elderly people requiring care is going up. We heard evidence that although the Care Act was great legislation in principle, all was not delivered in practice. The extra measures are welcome in trying to reward staff properly for the excellent work that many of them do in social care, but the increase in the minimum wage places additional costs on the system.

Amyas Morse, who wrote a very good article and made a good speech the other day about the relationship between health and social care, said that for a long time local authorities had been very successful in doing more for less, but have now got to the point of doing less for less, which is impacting on the people who received the services.

We should not blame local councils for failing to provide a certain standard of service. Simon Stevens told the Communities and Local Government Committee that even if every council did as well as the best, there would still be problems in the system. I challenged the Under-Secretary of State for Health, the hon. Member for Warrington South (David Mowat), to say whether there was a crisis in social care. He did not want to use the word “crisis”, but he did say that the system was “under stress”. Although we cannot agree about the word “crisis”, I think we can at least agree that the stress is obvious for all to see. An estimated 1.2 million people do not receive the care they need. That figure is 40% higher than it was in 2010.

We took evidence from people who were not getting the same amount of care as they had received in the past and others whose needs were increasing but whose care was not. We talked to care providers who were handing contracts back or pulling out of the service altogether, and to local authorities that are sacking care providers because the contracts were not being delivered properly. We also heard that people who pay for their care in care homes are subsidising local authorities because they cannot afford to keep increasing their fees. There is a cross-subsidy in the system, which does not seem fair to many people. At the same time, the turnover rate for care staff is 27%, so they do not have long-term experience and are not being trained regularly over time to deliver care. Those are all problems that we learned about from the compelling evidence that our inquiry received. The Committee will reflect on its conclusion, and I am sure that eventually we will, as always, come to an unanimous view in our report.

In the short term, of course the Government have done things, including the introduction of the council tax precept. I welcome the fact that, by and large, local authorities have taken that up, because the situation is so serious. There are problems, of course, with the fact that the council tax precept raises much more money for some local authorities than for others, and the better care fund, which is meant to stabilise the situation and help authorities that raise less, is back-end loaded. The new homes bonus cut and the additional grant are welcome for social care, but that causes real problems for some small district councils that are not social care providers and suddenly find that their budget position is fundamentally altered.

In his article, Amyas Morse described how the Government simply were not thinking through what would happen in the long term. They moved money—it is often a lack of money—around between social care and health without giving any real thought to the end result. Government officials, and sometimes Ministers, took decisions without any real understanding of what happened to the money at the end of the line, when local authorities faced with very difficult choices had to make decisions about the cuts that were being passed on to them. Those are just some of the issues on which we will reflect in our report.

Clearly, the link between health and social care is very important. We ought to join them up better and it will be interesting to see what comes out of the Manchester example, given that both services have been devolved. There is a clear link between the two, and not just with regard to delayed discharging; there is now virtually no money in the system for preventive social care. The only social care funding available is that for people with the highest need. If people do not get it in the early stages, that means that they are more likely to end up in hospital and cost the whole system much more. That is another thing that we learned.

I was pleased to sign, along with the Chairs of the Health Committee and of the Public Accounts Committee, the letter to the Prime Minister saying that we need longer-term arrangements. It is right, however, that the Government should respond to the here and now, because that is important. To put it bluntly, if we do not deal with the here and now, some people will not be around to see the long-term arrangements being put in place.

When the Communities and Local Government Committee went to Germany, we learned that it solved this problem 20 years ago. Those involved sat down on a cross-party basis and agreed a long-term solution. It might not be the right solution for this country—it is based on social insurance, because that is what the German health system, as well as its pensions system, is based on—but that is what they decided to do. It is interesting that it has stood the test of time for 20 years. They have recently decided, with cross-party agreement, to increase social insurance and there has been virtually no public opposition, because the system is seen to be reasonable and fair. The German system is not purely funded by the taxpayer—there are private contributions as well—but it is an example. For heaven’s sake, let us sit down on a cross-party basis, as the Chair of the Health Committee has said, and work out a solution that stands the test of time, whichever Government comes to power in the future.

[Dr Murrison]

There is much in the hon. Gentleman’s speech with which I agree. Does he agree that the fundamental issue is that countries such as Germany, France and Holland, to which people here would reasonably compare this country, spend a great deal more money through either the Bismarckian system that he describes or others—this country’s system is based on Beveridge—and that somehow or another we are going to have to close that gap, as it is highly likely that the difference in mortality, morbidity and outcomes generally in this country compared with those aforementioned countries is causally related to the amount of money that we put into healthcare?

[Mr Betts]

We heard quite a lot of evidence that, as a percentage of our national income, we do not spend as much as several others on health and social care combined. The Communities and Local Government Committee will reflect on that. Of course, it is not simply a question of asking for more public funding; I would not come to that conclusion, although I might personally believe it. There is, however, an issue with where we get the private funding from, because nobody has argued to us so far that the whole of social care can be publicly funded. There will be private contributions, so how do we raise that private money? Should it come from individuals who simply need care at that point in time, or should we ask people to pay more into an insurance system? How do we put in more money from the public sector? Indeed, can we rely on local authority funding alone, particularly if it comes largely from business rates, which will not grow at the same rate as the number of people who want social care?

[Kevin Hollinrake (Thirsk and Malton) (Con)]

rose—

[Dr Murrison]

rose—

[Mr Betts]

I give way to my Select Committee colleague, the hon. Member for Thirsk and Malton (Kevin Hollinrake).

[Kevin Hollinrake]

It was a pleasure to join the hon. Gentleman and other members of the Select Committee on that visit. Does he agree that the German example is all the more pertinent given that its system was also funded by local authorities prior to the change to social insurance in 1995? It discovered 20 years ago that that system was not fit for purpose and moved to a new system that, as he says, has cross-party support and is a long-term, sustainable solution.

[Mr Betts]

I just want us to have a process that gets us to a similar position. Even if local authorities remain part of the funding solution, we cannot assume that the increase in business rates and council tax will keep pace with the level of demand.

I know that you have encouraged us to keep to a time limit, Madam Deputy Speaker.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I ought to say that, as the hon. Gentleman is the Chairman of a Select Committee, I do not apply the time limit as strictly to him.

[Mr Betts]

I have gone two minutes over time, so I had better not stray too far. Of course, health and social care need to work closely together. It is going to be very interesting to see how Manchester develops. It is not, however, a panacea; it is not going to solve all the problems.

I agree with the Chair of the Health Committee: the sustainability and transformation plans are an interesting way forward, but unfortunately they are seen as a way of making cuts. They will need some pump-priming to make them effective. They have not been done properly, with full co-operation, in every local authority area. If they are done properly and consider how we can better plan and pull together health and social care for the future, I think they will make an important contribution. Ultimately, however, we have to acknowledge that the process is going to take time and that it will need up-front funding to make it work.

We also have to acknowledge that there are big differences between health and social care. There are not many differences in culture, but the funding arrangements are different. Health is provided free at the point of use, whereas social care is not and probably will not after any changes are made. There is also a fundamental difference between the two on accountability: social care is accountable to directly elected local councillors, whereas health is ultimately accountable to the Secretary of State. If Members want to see the problems that creates, they should read the evidence that the former Health Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), gave to the Communities and Local Government Committee about his understanding of accountability in the Manchester system. It shows that the Government have not worked it out in such a way that they could flick a switch tomorrow and get it all operating smoothly. We have a lot of work to do. The Select Committee will consider all the evidence we have received and will produce reports on a range of issues.

--- Later in debate ---

[David Mowat]

The money is what we were asked to provide by NHS England’s senior management, and we provided it. At that time, the chief executive said that the Government had listened and acted. That is what we did, and that money is now available. That is not the same as saying that we do not accept that the system is under pressure in certain ways. Again, though, we talk about the money that is being spent in France and Germany. In Munich, 15 of the city’s 19 hospitals stopped taking people in over this winter. Right across the world—this is the point—there are challenges in national health systems, and we need to work to ensure that money is spent as effectively as possible. We know that £120 billion will be in our health system in 2020. What this Government have to do and what this ministerial team is doing is ensure that every penny is spent as effectively as possible.

We have talked about the five year forward view, and I accept that we are two years into it, but we know that the health system must tilt back towards community health, and the STPs are part of making that happen. We know that we need to get better than we are so far in terms of mental health and parity of esteem.

[Mr Betts]

I think the STP approach is capable of being a good one. The problem is that when I go to the chief executive of the Sheffield Teaching Hospitals NHS Trust, Sir Andrew Cash, who is respected in government as well, he tells me that the process of transferring resources to the community will not work unless there is some transitional upfront funding for the whole process. We cannot stop doing what is being done in the hospitals and simply transfer it to the community.

[David Mowat]

He is right about that. NHS England is evaluating the STPs at the moment and during March and April, and it will decide which STPs are high priority, which will be invested in and which will be taken forward at speed. We heard the phrase “accountable care organisations” used earlier, and it is the Government’s intention to ensure that those high-performing STPs that we proceed with—it will not be all of them; frankly, the standards are variable and locally driven—will in time become accountable care organisations.

The shadow Minister asked me to talk about social care, and I will do so. During the present Parliament, accessible funding for social care has risen by 6% in real terms; it fell during the last Parliament. Last year 42% of councils increased their social care budgets in real terms, and in December £900 million was provided in new homes bonus payments.

--- Later in debate ---

[David Mowat]

The Care Act 2014 was introduced by this Government, and it has transformed social care, although we accept that the system is under pressure. The number of delayed transfers of care in Newcastle, St Helens, Bedford and Nottingham is nil. The Chairman of the Public Accounts Committee, the hon. Member for Hackney South and Shoreditch (Meg Hillier), said that she had been told by Simon Stevens that if the top-performing councils—in terms of delayed transfers—were emulated by all the rest, the consequence would be very small. The truth is that there is a 30 times difference between the top 10% of councils and the bottom 10%.

[Mr Betts]

Will the Minister give way?

[David Mowat]

No. I have given way to the hon. Gentleman twice already, and I need to finish my speech in two minutes.

We accept that there are challenges and pressures in social care, but we also know that we need to make progress in mental health care, and we are doing so by working towards parity of esteem. By 2020, there will be 5,000 more doctors in general practice and 2,000 more pharmacists. We have talked about the need for more pharmacists. I visited a pharmacist’s practice in Perivale on Friday, and I know that we can transform the way in which general practices work. There will be 3,500 mental health therapists as well.

Nearly 3 million people work in healthcare, in the NHS and care sectors. Many of them are remarkable people doing remarkable things, and they deserve our support. It is important for us not to weaponise this entire discussion. It is important for us not to produce election leaflets about dead babies, and all that that means. Our healthcare system and the NHS deserve our support, and the Government are committed to ensuring that they receive it. I commend the estimate to the House.